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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 April 28; 334(7599): 864.
PMCID: PMC1857780
Coeliac Disease

Decision tool needs to be developed for children

Jonas F Ludvigsson, consultant paediatrician1 and Anneli Ivarsson, epidemiologist2

The decision tool for coeliac disease developed by Hopper et al is restricted to adults.1 However, coeliac disease often presents in childhood when symptoms and signs can be different from those in adulthood.2 3 It may therefore be inappropriate to use the clinical characteristics suggested by Hopper et al when dividing children into high risk and low risk groups with respect to coeliac disease.

The second part of the clinical decision tool of Hopper et al is testing with tissue transglutaminase autoantibodies.1 Also here clinicians need to consider the implications of age. In a recent review by Rostom et al,4 the pooled sensitivity of human tissue transglutaminase IgA autoantibodies was lower in children (95.7%) than in adults (98.1%); more false negative cases can therefore be expected.

We therefore suggest that the clinical decision tool proposed by Hopper et al should be adapted for children, and thereafter tested prospectively in an unselected population.


Competing interests: None declared.


1. Hopper AD, Cross SS, Hurlstone DP, McAlindon ME, Lobo AJ, Hadjivassiliou M, et al. Pre-endoscopy serological testing for coeliac disease: evaluation of a clinical decision tool. BMJ 2007;334:729-32. (7 April.) [PMC free article] [PubMed]
2. Fasano A. Clinical presentation of celiac disease in the pediatric population. Gastroenterology 2005;128(4 suppl 1):S68-73. [PubMed]
3. Ludvigsson JF, Ansved P, Falth-Magnusson K, Hammersjo JA, Johansson C, Edvardsson S, et al. Symptoms and signs have changed in Swedish children with coeliac disease. J Pediatr Gastroenterol Nutr 2004;38(2):181-6. [PubMed]
4. Rostom A, Dube C, Cranney A, Saloojee N, Sy R, Garritty C, et al. The diagnostic accuracy of serologic tests for celiac disease: a systematic review. Gastroenterology 2005;128(4 suppl 1):S38-46. [PubMed]

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