Serious flaw in Joint BSPGHAN and Coeliac UK Guidelines

Celiac diagnostic guidelines

Celiac diagnostic guidelines

It is my opinion that gastroenterology groups who developed diagnostic guidelines for celiac disease have forgotten that they are dealing with very real people who have significant illness.   They seem to have forgotten about the suffering of the children, the anguish of their parents, and the potential serious health implications of late diagnosis.  This is a serious flaw.

I believe that attention should be focussed on early diagnosis, not end-stage disease.

My outburst has been provoked by the “Joint BSPGHAN and Coeliac UK Guidelines for the Diagnosis and Management of Celiac Disease in Children” http://www.medscape.com/viewarticle/811355_2?nlid=36263_455

Serious flaw in Joint BSPGHAN and Coeliac UK Guidelines

The authors state that “This article is an attempt to simplify and shorten the diagnostic process of celiac disease in selected cases.”   However, I have a number of serious comments to make. My first point is that this guideline not simple!  It is a complex algorithm which needs a lot of thought as to the value of each test. However, my main concern is  about their philosophy  of waiting until there is established gut damage in these children before making a diagnosis of celiac disease, or a  gluten-related disorder.
Why wait until they gut tissue is substantially damaged? Why wait for many years with the child having symptoms before permitting adopt a gluten-free diet?  Why wait for growth failure?  Why wait for established autoimmune disease?  Why have such a narrow focus on the gut tissue histology?
It is my opinion that children should be treated as early as possible. They need to have the opportunity to grow and feel well. Elevated levels of TTG, EMA, and DGP are very likely to be early celiac disease. Especially, if the child has gluten related symptoms. And especially, if they are positive for the DQ2/DQ8 alleles. It is also likely that early gluten avoidance will lessen the chance of later autoimmune disease.
Would you let someone with high cholesterol levels and high blood pressure wait for treatment until they had a heart attack?
My plea is to treat children early. I am currently writing a book called “How early can you diagnose celiac disease?”  Surely an ounce prevention is better than a ton of a possible cure.
(By the way, this Guideline is not relevant to gluten-related disorders)
By Rodney Ford