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Coeliac No-Biopsy Diagnosis — RACP Paediatrics MCQ

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ModerateGastroenterologyCoeliac No-Biopsy DiagnosisRACP Paediatrics

A 3-year-old presents with failure to thrive. Anti-tTG is markedly elevated (>100 U/mL, 10x ULN). Anti-endomysial antibody is positive. HLA-DQ2 is positive. Can coeliac disease be diagnosed without a biopsy?

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Correct answer: E — Yes – if tTG >10x ULN, positive EMA on a separate sample, positive HLA-DQ2/DQ8, and clinical symptoms consistent with coeliac disease

ESPGHAN 2020 guidelines (adopted in Australia) allow a no-biopsy diagnosis of coeliac disease in symptomatic children if: tTG-IgA >10x ULN on two separate occasions, positive EMA on a second sample, positive HLA-DQ2/DQ8, and concordant clinical features. This avoids endoscopy in clear-cut cases.

Reference: AUSPGHAN – 2024 – Position Statement on Coeliac Disease Diagnosis