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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.