OC91 Evaluating current practice of managing patients with coeliac disease against European (ESPGHAN) standards of care
Published Date: 20th August 2025
Publication Authors: Emmence. L, Kan. J, Bokhari. F, Roberts. M, Elbadri. A
Abstract
An ESPGHAN position paper on follow-up of children and adolescents with Coeliac Disease (CD) (2022)1 recommended ten standards of care. We aimed to assess the historical compliance of a busy district general hospital (DGH) service with these guidelines.
A retrospective review was completed of CD patients (N=54) in the paediatric gastroenterology clinic at a DGH from 01/01/2010 to 31/07/2023. Data were collected from health records using a specifically designed audit tool. Diagnostic criteria were assessed against the latest criteria at the time of diagnosis, and ongoing management against the ESPGHAN recommendations.2 3
Mean age at diagnosis was 6.7 years. Serological diagnostic criteria were met in 69%, and 31% diagnosed histologically. One patient did not meet the contemporaneous diagnostic criteria but had borderline serology with persistent symptoms.
All patients received follow-up; 93% within 3–6 months of commencing a gluten-free diet; 98% every 12–24 months afterwards. All patients were followed up by a consultant, with 87% seen by a dietician.
Approximately 85% were signposted to Coeliac UK for further information and support.
All patients had serial aTTGs measured as appropriate.
Compliance to ESPGHAN’s initial blood test recommendations1 was varied. Full blood count was measured within 6 months of diagnosis in 89% of patients; liver function tests in 83%; thyroid function tests in 76%; vitamin D in 76%; iron/ferritin in 62%; and vitamin B12 in 24%.
All patients had gastrointestinal symptoms and adherence to a gluten-free diet assessed at each follow-up appointment, 94% had extraintestinal symptoms assessed.
Height and weight were stated in 94% and 96% of follow-up appointments, respectively, with centiles stated in 72% and 76%.
Quality of Life (QoL) was not formally assessed in any patient.
Diagnostic criteria were satisfactorily met.
Fewer avoidable biopsies have been performed since the 2020 guidelines2 were released (0%, compared to 18%), perhaps reflecting a benefit of a simpler diagnostic algorithm.
An order set of monitoring investigations has been put in place to ensure that all appropriate bloods are requested in future.
Proformas for both initial diagnosis and annual review appointments have been updated to ensure adequate compliance with ESPGHAN recommendations.
The ESPGHAN guidelines1 recommend QoL scores for children with CD,4 plus referral onto a psychologist with CD knowledge if required. No such service exists in this DGH or region, therefore these recommendations were not met, and current service provisions will be explored further.
Emmence, L; Kan, J; Bokhari, F; Roberts, M; Elbadri, A. (2025). OC91 Evaluating current practice of managing patients with coeliac disease against European (ESPGHAN) standards of care. Frontline Gastroenterology. 16(Suppl 1), pp.A63-A64. [Online]. Available at: https://doi.org/10.1136/flgastro-2025-bspghan.90 [Accessed 6 October 2025]
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