Adherence to Celiac Disease and Eosinophilic Esophagitis Biopsy Guidelines is Poor in Children

OBJECTIVES:: Celiac disease (CD) and eosinophilic esophagitis (EoE) are underdiagnosed gastrointestinal conditions which adversely impact childrenʼs health. Prior studies have shown that diagnostic guidelines for CD are not consistently followed in adults. The aims of this study are to assess the frequency with which endoscopists comply with diagnostic guidelines for CD and EoE in children, and to determine whether an association exists between adherence to biopsy guidelines and disease detection in pediatric patients. METHODS:: We reviewed pathology reports from 9171 children (ages 0–18) with at least one duodenal biopsy, and 8280 children with at least one esophageal biopsy, with specimens submitted to a national pathology laboratory. Frequency of adherence to diagnostic guidelines and recommendations for CD and EoE were determined, as well as the impact of this upon detection of CD and EoE. RESULTS:: Overall, 35% of cases were biopsied according to the 2006 American Gastroenterological Association (AGA) guidelines for CD diagnosis; 8% were biopsied according to the 2007 AGA EoE consensus recommendations. Detection of CD and EoE increased with the number of biopsies collected (p for trend in each?<?0.001). Adherence to diagnostic guidelines was particularly poor among those found to have histologically normal mucosa in both cohorts. The likelihood of CD and EoE diagnosis was significantly associated with adherence to diagnostic guidelines (OR for CD 6.3, 95% CI 4.4–8.9; OR for EoE 2.4, 95% CI 1.9–2.9). CONCLUSIONS:: Adherence to established guidelines is poor, and improved guideline adherence is associated with greater disease detection rates for CD and EoE.