# Laboratory and Clinical Practices in the Study of Coeliac Disease in Children and Adults: Recommendations from a Spanish Multicentre Survey

## TL;DR

This study surveyed Spanish labs to assess their practices for diagnosing coeliac disease and found inconsistent adherence to guidelines, especially in pediatric cases.

## Contribution

The study provides insights into current diagnostic practices and highlights gaps in implementing recent pediatric coeliac disease guidelines.

## Key findings

- All labs used tTG-IgA and total IgA for serological screening.
- Use of anti-endomysial antibody testing and HLA genotyping varied across labs.
- Most labs had not fully adopted the 2020 ESPGHAN pediatric guidelines.

## Abstract

Background/Objectives: Coeliac disease is an immune-mediated disorder of the gastrointestinal tract that may result in significant nutritional deficiencies. Effective management requires strict, lifelong adherence to a gluten-free diet. Both underdiagnosis and unnecessary dietary restrictions can adversely affect patients’ health and quality of life. To assess adherence to the current recommendations for the laboratory diagnosis of coeliac disease and promote evidence-based practices while reducing inter-laboratory variability, the Spanish Group on Autoimmunity of the Spanish Society of Immunology conducted a nationwide survey. Methods: A thirty-item survey was distributed to fifty autoimmune laboratories across Spain. Data were collected through a structured Excel-based questionnaire comprising multiple-choice items, which was distributed via email to the participating laboratories. It explored practices related to the diagnosis of coeliac disease in the general population and among at-risk groups as well as approaches to patient follow-up and demand management. Results: Thirty-five laboratories completed the electronic questionnaire. For the serological screening of coeliac disease, all the respondents reported using IgA anti-tissue transglutaminase (tTG-IgA) antibody testing together with total IgA measurement to assess IgA competence. However, consistent use of anti-endomysial antibody testing and HLA genotyping and adherence to pre-analytical recommendations for accurate interpretation of results were not uniform across centres. Conclusions: At the time these data were collected (the third trimester of 2021), the 2020 ESPGHAN guidelines for the diagnosis of coeliac disease in the paediatric population had not yet been fully implemented in most of the laboratories surveyed. For diagnosing adults, most laboratories adhered to local and European guidelines.