The authors reference as the basis for their summary the different evidence based guidelines that have been developed over recent years, and a literature search, whose search strategy included,among others, all publications from the past 10 years identified by using the search terms “celiac disease” and “diagnosis”
S Razeghi focuses on the importance of symptoms in the ESPEGHAN recommendation for the rare case in which a duo-denal biopsy is not needed (in a child or adolescent with at least tenfold raised anti-TG2-IgA and EMA confirmation, positivity for HLA-DQ2 or DQ8). If this is applied in any symptom that raises suspicions of celiac disease (for example, abdominal pain), the expected result will be diagnostic overkill. The ESPAGHAN guidelines refer, among others, to the Dahlborn study (reference 27 in our article) (1), in which a highly significant or a significant difference in the TG2-IgA titers existed between children with severe malabsorption and mild symptoms.
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