Paeds Vivas · gastroenterology-hepatology-and-nutrition
Coeliac disease — branching viva
Branching viva from the definition and pathogenesis of coeliac disease through the classic toddler, the adolescent with refractory iron deficiency, the child with type 1 diabetes, and the atypical presentation, testing the ESPGHAN 2020 no-biopsy pathway, the gluten-on-board rule and the selective immunoglobulin A deficiency trap.
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RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in a general clinic. The consultant asks you to talk through four children referred with possible coeliac disease: a classic toddler with diarrhoea and failure to thrive, a fourteen-year-old with refractory iron-deficiency anaemia and short stature, an eight-year-old with type 1 diabetes and a positive screen, and a child whose family has already started a gluten-free diet.
Station opening
Examiner: "Define coeliac disease and outline your approach to a child referred with possible coeliac disease." [1]
Strong candidate (must-hit)
- Defines coeliac disease as a permanent, immune-mediated small-bowel enteropathy induced by dietary gluten in people who carry HLA-DQ2 or HLA-DQ8; frames the approach around recognising the classic and non-classic faces, confirming the diagnosis with immunoglobulin A anti-tissue-transglutaminase plus a total immunoglobulin A taken while the child is still eating gluten, applying the ESPGHAN 2020 no-biopsy pathway when the criteria are met, and treating with a strict lifelong gluten-free diet with monitoring; states that the gluten-on-board rule is the single most important practical principle. [1]
Weak candidate
- "Coeliac disease is an allergy to wheat, and I would test for it and start a gluten-free diet." [1]
References5ShowHide
- [1]Husby S; Koletzko S; Korponay-Szabó I; Kurppa K; Mearin ML; Ribes-Koninckx C European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020 J Pediatr Gastroenterol Nutr, 2020.PMID 31568151
- [2]Hill ID; Fasano A; Guandalini S; Hoffenberg E; Levy J; Reilly N NASPGHAN Clinical Report on the Diagnosis and Treatment of Gluten-related Disorders J Pediatr Gastroenterol Nutr, 2016.PMID 27035374
- [3]Giersiepen K; Lelgemann M; Stuhldreher N; Ronfani L; Husby S; Koletzko S Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report J Pediatr Gastroenterol Nutr, 2012.PMID 22266486
- [4]Werkstetter KJ; Korponay-Szabó IR; Popp A; Villanacci V; Salemme M; Heilig G Accuracy in Diagnosis of Celiac Disease Without Biopsies in Clinical Practice Gastroenterology, 2017.PMID 28624578
- [5]Mearin ML; Agardh D; Antunes H; Al-Toma A; Auricchio R; Castillejo G ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease J Pediatr Gastroenterol Nutr, 2022.PMID 35758521