ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease

AIM: To gather the current evidence and to offer recommendations for follow-up and management.METHODS: The Special Interest Group on Coeliac Diseases of the European Society of Paediatric Gastroenterology Hepatology and Nutrition formulated ten questions considered to be essential for follow-up care. A literature search (January 2010 - March 2020) was performed in PubMed or Medline. Relevant publications were identified and potentially eligible studies were assessed. Statements and recommendations were developed and discussed by all co-authors. Recommendations were voted upon: joint agreement was set as at least 85%.RESULTS: Publications (n=2775) were identified and 164 were included. Using evidence and/or expert opinion, 37 recommendations were formulated on: The need to perform follow-up, its frequency and what should be assessed, how to assess adherence to the gluten-free diet, when to expect catch-up growth, how to treat anaemia, how to approach persistent high serum levels of antibodies against tissue-transglutaminase, the indication to perform biopsies, assessment of quality of life, management of children with unclear diagnosis for which a gluten challenge is indicated, children with associated type 1 diabetes or IgA deficiency, cases of potential coeliac disease, which professionals should perform follow-up, how to improve the communication to patients and their parents/caregivers and transition from paediatric to adult health-care.CONCLUSIONS: We offer recommendations to improve follow-up of children and adolescents with coeliac disease and highlight gaps that should be investigated to further improve management.