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IMPACT OF SEROLOGY-BASED CELIAC DISEASE DIAGNOSIS ON PEDIATRIC PATIENTS’ OUTCOME

Iulia Enache 1,2, Alexandra Palaga 3, Daniel Vasile Balaban 1,2, Diana Czika 3, Mariana Jinga 1,2, Alina Popp 1,3

Affiliations

1 University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

2 Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania

3 National Institute for Mother and Child Health, Bucharest, Romania

Summary

AI Generated

Retrospective study comparing biopsy-based versus serology-based celiac disease diagnosis in 63 children found trends toward faster recovery and better long-term adherence in the biopsy-diagnosed group.

30 children were diagnosed by biopsy and 33 by serology only during 2010-2014, a period overlapping the 2012 ESPGHAN guideline change that removed biopsy requirements for certain symptomatic children
Both groups showed improvement in gastrointestinal symptoms on gluten-free diet, but the biopsy-based group showed better treatment outcomes at 1 and 2 years, including faster BMI Z-score normalization and greater reduction in anemia
After 2 years on gluten-free diet, autoantibodies remained elevated in a majority of both groups, with 58.3% TG2-IgA positivity in the serology group versus 50% in the biopsy group
At long-term follow-up (median 8.7-10 years), anemia had resolved in both groups, but 4 serology-diagnosed and 8 biopsy-diagnosed children still showed elevated antibodies
The biopsy-proven group appeared more compliant with follow-up visits and more adherent to the gluten-free diet over the long term

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Abstract

Introduction

Celiac disease (CD) is an immune-mediated systemic disease, triggered by the ingestion of gluten, which only develops in genetically predisposed individuals. The main characteristics of the disease are the gluten-dependent small intestinal mucosal lesion, villous atrophy and crypt hyperplasia, and the production of the specific serum autoantibodies. The gold standard for diagnosis has been based on the biopsy findings. In 2012, new ESPGHAN diagnostic guidelines removed the necessity of duodenal biopsy in symptomatic children showing a high serum transglutaminase 2 titers (TG2-IgA) together with the presence of endomysial antibodies (EmA) and HLA DQ2 and/or DQ8.

Aims & Methods

Our aim was to assess the clinical outcome of the diagnostic change in children by comparing new serology-based diagnosed patients to the biopsy-based ones.
We conducted a retrospective analysis of data collected from the medical charts of the patients diagnosed during a four-year period, from 2010 to 2014, being a time overlapping the guideline change. From a total of 63 patients, 30 were biopsy-diagnosed and 33 diagnoses were based on serology only. Clinical data and laboratory parameters were compared between the groups at diagnosis and at follow-ups at 1 year, 2 years and at their latest follow-up visit during the gluten-free diet (GFD) treatment, median time 8.7 years for the serology-based group and 10 years for the biopsy-based group.

Results

Our results show clear improvement upon GFD in gastrointestinal symptoms in both groups. However, there was a general trend for better treatment outcomes in the biopsy-based group compared to the serology-based group at 1 and 2 years of follow-up. Body mass index Z score was in the biopsy group at baseline -1.5, at 1 year on GFD -0.2 and at 2 years -0.2. The corresponding results in the serology group was -1.51, -0.8 (p=0-056), and -1.35 (p=0.023). Anemia was observed in the serology group at one year as frequently (25%) as at baseline (26.7%) but in the biopsy group improvement from baseline was seen, 27.4% to 7.1 % of patients. At two years, anemia was present in 16.6% of patients. Ferritin values were significantly lower in the serology group at one year (27.5 µg/L vs 59, p=0.040) but not anymore at 2 years. After two years on GFD both TG2-IgA and EmA were often still above the cut-off for positivity in both diagnostic groups (serology group 58.3 % and 50% respectively and in the biopsy group somewhat less, 50% and 28.6% respectively). At long term, no anemia was present anymore. However, 4 children from serology group and 8 from the biopsy group showed antibodies above cut-off even after 8.7 and 10 years of treatment, respectively. Upon long-term follow-up the patients from the biopsy-proven group seemed to be more compliant with the follow-up visits and more adherent to the gluten-free diet.

Conclusion

Both clinical and laboratory results show slow recovery upon gluten-free diet. High percentage of autoantibody positivity still at 2 years on GFD indicates substantial amounts of gluten in the diet. Biopsy-proven patients seemed to have a faster recovery than the serology-diagnosed. Serological diagnosis also appears to negatively influence the adherence and compliance to treatment and follow-up. Novel (drug/vaccine) treatments adjunctive to GFD are an unmet need also in children. Duodenal mucosal recovery results on long-term GFD are warranted.

Conference

UEG Week Vienna 2024

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

SMALL INTESTINAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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SUSTAINED LONG-TERM EFFECT OF SPECIALISED GASTROENTEROLOGICAL TREATMENT FOR BOWEL DYSFUNCTION AFTER PELVIC AND COLON CANCER TREATMENT: A PROSPECTIVE COHORT STUDY

Janne Ladefoged Fassov

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SUSTAINED LONG-TERM EFFECT OF SPECIALISED GASTROENTEROLOGICAL TREATMENT FOR BOWEL DYSFUNCTION AFTER PELVIC AND COLON CANCER TREATMENT: A PROSPECTIVE COHORT STUDY

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SUSTAINED LONG-TERM EFFECT OF SPECIALISED GASTROENTEROLOGICAL TREATMENT FOR BOWEL DYSFUNCTION AFTER PELVIC AND COLON CANCER TREATMENT: A PROSPECTIVE COHORT STUDY

Louise Kuhlmann Asferg 1, Jakob Lykke Poulsen 1, Asbjørn Mohr Drewes 1, Klaus Krogh 2, Mette Borre 2, Therese Juul 2, Peter Christsensen 3, Janne Ladefoged Fassov 4

Affiliations

1 Aalborg University Hospital, Gistrup, Denmark

2 Aarhus University Hospital, Aarhus N, Denmark

3 Aarhus University Hospital, Aarhus, Denmark

4 Diagnostisk Center (Medicinsk afd.), Aarhus, Denmark

Summary

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Summary is not available for this content yet.

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Abstract

Introduction

Bowel dysfunction is a frequent, debilitating late effect following cancer treatment. Gastroenterological late-sequelae clinics have been established in Denmark, offering systematic evaluation and targeted treatment. In this setting, we aimed to examine treatment-related changes in diarrhoea-predominant symptoms among cancer survivors, and how they impact quality-of-life.

Aims & Methods

This prospective cohort study included survivors of pelvic organ or colon cancer with diarrhoea-predominant symptoms. A first clinical visit (baseline) a structured protocol-guided clinical evaluation was conducted, including blood tests, breath tests for small intestinal bacterial overgrowth (SIBO), and selenium-75 homocholic acid taurine (SeHCAT) scans when indicated. Treatment was directed by findings and included antibiotics for SIBO, bile acid sequestrants or dietary modification for bile acid malabsorption (BAM), and symptom-oriented pharmacological or dietary interventions. Patient-reported outcome measures were collected at baseline, final clinical visit (discharge), and after 1 and 3 years.

Results

Among 534 referred patients, 339 were eligible for analysis. 271 completed 12-month follow-up, and 158 completed 36-month follow-up at data cut off. In tested patients BAM was identified in 66.9%, and SIBO in 62.6%. Bowel symptoms, perceived bowel function, and quality-of-life all improved during follow-up (all p<0.001). For example, self-rated bowel function improved in 59% at discharge, 51% at 12 months, and 59% at 36 months, with similar patterns across outcomes and cancer types.

Conclusion

Structured assessment and targeted management in late-sequelae clinics for cancer survivors was associated with considerable and sustained improvements in bowel symptoms and their life impact three years after last visit.

Event

UEG Week Barcelona 2026

Topics

Endoscopy Surgery Mechanisms & Personalised Medicine Colorectal

Submission format

Abstract

Session

Lower GI disorders: A multidisciplinary approach

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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SUSTAINED LONG-TERM EFFECT OF SPECIALISED GASTROENTEROLOGICAL TREATMENT FOR BOWEL DYSFUNCTION AFTER PELVIC AND COLON CANCER TREATMENT: A PROSPECTIVE COHORT STUDY

Janne Ladefoged Fassov

Episode 6: UEG Journal October Spotlight

Maria Manuela Estevinho

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UEG Podcast Episode

Journal Podcast

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Episode 6: UEG Journal October Spotlight

Mohsan Subhani, Maria Manuela Estevinho

Summary

AI Generated

Summary is not available for this content yet.

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Abstract

Topics

Endoscopy Hepatobiliary IBD Pancreas

Published

2025

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SUSTAINED LONG-TERM EFFECT OF SPECIALISED GASTROENTEROLOGICAL TREATMENT FOR BOWEL DYSFUNCTION AFTER PELVIC AND COLON CANCER TREATMENT: A PROSPECTIVE COHORT STUDY

Janne Ladefoged Fassov

Episode 6: UEG Journal October Spotlight

Maria Manuela Estevinho

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Jeffrey Lazarus

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Joana Roseira

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UEG Presentation

New

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Metabolic liver diseases: Today and tomorrow

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Metabolic liver diseases: Today and tomorrow

Jeffrey Lazarus 1

Affiliations

1 Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain

Summary

AI Generated

Summary is not available for this content yet.

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Abstract

Event

UEG Week Barcelona 2026

Topics

Mechanisms & Personalised Medicine Immunology

Session

The future of immune-mediated metabolic diseases

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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SUSTAINED LONG-TERM EFFECT OF SPECIALISED GASTROENTEROLOGICAL TREATMENT FOR BOWEL DYSFUNCTION AFTER PELVIC AND COLON CANCER TREATMENT: A PROSPECTIVE COHORT STUDY

Janne Ladefoged Fassov

Episode 6: UEG Journal October Spotlight

Maria Manuela Estevinho

Metabolic liver diseases: Today and tomorrow

Jeffrey Lazarus

Newly diagnosed Crohn’s disease

Joana Roseira

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Frank Zerbib

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Miroslav Vujasinovic

UEG Presentation

New

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Newly diagnosed Crohn’s disease

Joana Roseira 1

Affiliations

1 Algarve Universitary Hospital Center, Portimão, Algarve, Portugal

Summary

AI Generated

Summary is not available for this content yet.

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Abstract

Event

UEG Week Barcelona 2026

Topics

Colorectal Surgery IBD

Session

Mistakes in… Lower GI

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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SUSTAINED LONG-TERM EFFECT OF SPECIALISED GASTROENTEROLOGICAL TREATMENT FOR BOWEL DYSFUNCTION AFTER PELVIC AND COLON CANCER TREATMENT: A PROSPECTIVE COHORT STUDY

Janne Ladefoged Fassov

Episode 6: UEG Journal October Spotlight

Maria Manuela Estevinho

Metabolic liver diseases: Today and tomorrow

Jeffrey Lazarus

Newly diagnosed Crohn’s disease

Joana Roseira

GORD: Is it all acid?

Frank Zerbib

Pancreatic exocrine insufficiency

Miroslav Vujasinovic

UEG Presentation

New

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

GORD: Is it all acid?

Frank Zerbib 1

Affiliations

1 CHU de Bordeaux - Hôpital Haut Leveque, Pessac, France

Summary

AI Generated

Summary is not available for this content yet.

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Abstract

Event

UEG Week Barcelona 2026

Topics

Endoscopy Oesophagus

Session

Gastro-oesophageal reflux: How to keep the acid down?

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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SUSTAINED LONG-TERM EFFECT OF SPECIALISED GASTROENTEROLOGICAL TREATMENT FOR BOWEL DYSFUNCTION AFTER PELVIC AND COLON CANCER TREATMENT: A PROSPECTIVE COHORT STUDY

Janne Ladefoged Fassov

Episode 6: UEG Journal October Spotlight

Maria Manuela Estevinho

Metabolic liver diseases: Today and tomorrow

Jeffrey Lazarus

Newly diagnosed Crohn’s disease

Joana Roseira

GORD: Is it all acid?

Frank Zerbib

Pancreatic exocrine insufficiency

Miroslav Vujasinovic

UEG Presentation

New

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Pancreatic exocrine insufficiency

Miroslav Vujasinovic 1

Affiliations

1 Karolinska University Hospital, Stockholm, Sweden

Summary

AI Generated

Summary is not available for this content yet.

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Abstract

Event

UEG Week Barcelona 2026

Topics

Pancreas Hepatobiliary Endoscopy

Session

Mistakes in… Hepatobiliary and pancreas

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

SUSTAINED LONG-TERM EFFECT OF SPECIALISED GASTROENTEROLOGICAL TREATMENT FOR BOWEL DYSFUNCTION AFTER PELVIC AND COLON CANCER TREATMENT: A PROSPECTIVE COHORT STUDY

Janne Ladefoged Fassov

Episode 6: UEG Journal October Spotlight

Maria Manuela Estevinho

Metabolic liver diseases: Today and tomorrow

Jeffrey Lazarus

Newly diagnosed Crohn’s disease

Joana Roseira

GORD: Is it all acid?

Frank Zerbib

Pancreatic exocrine insufficiency

Miroslav Vujasinovic