Applying ESPGHAN and WGO Guidelines of Celiac Disease on Iraqi Patients
DOI:
https://doi.org/10.22317/jcms.v4i4.494Keywords:
Celiac disease, ESPGHAN criteria, WGO guideline, tTG (IgA) antibodies, challenge test, biopsy findingsAbstract
Objective: The goal of the study is to check the degree to which the physicians and pediatricians can apply ESPGHAN and WGO criteria of celiac disease (CD) on their patients in Karbala city.
Methods: This is a cross-sectional study conducted in Karbala city hospitals (Al-Hussein-medical city hospital, the pediatric teaching hospital) for the period from August 2017 to February 2018. A random selection of one hundred eight CD patients was carried out and the clinical data including the biopsy results were collected directly from patients or their family members via a questionnaire sheets. Statistically, the quantitative variables were analyzed using non-parametric t-test and the qualitative variables were analyzed using Chi-square test.
Results: The study shows that of the total 108 patients, only n=43 (39.8%) of candidates who did biopsy even with tTG IgA>10 fold ULN (200 RU/ml and more) due to the shortage in EMA/HLA tests recommended by ASPGHAN to omit duodenal biopsy., while n=51 (47.2%) accomplished only one of the triple tests (only tTG IgA>10 fold ULN) suggested by ASPGHAN and then applied challenge test and n=14 (12.9) achieved non of the triple tests (tTG IgA antibody titer>5 fold ULN, but <10 fold ULN). On the other hand, the WGO guideline is more suitable if properly applied as it considers tTG (IgA) a convenient substituent of EMA test where high tTG (IgA) serum level being diagnostic and to be confirmed by the available DGP (IgA and IgG) antibodies.
Conclusion: The WGO guideline for symptomatic and asymptomatic patients is more applicable for the areas with limited facilities, while ESPGHAN guideline for pediatrics can be applied to a less degree. Generally in Iraq there is a delay in disease diagnosis due to many reasons to be evaluated.
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