Eur J Pediatr. 2022 Mar;181(3):1213-1220. doi: 10.1007/s00431-021-04318-2.Epub 2021 Nov 24.

Margreet Wessels ^# 1, Jernej Dolinsek ^# 2 3, Gemma Castillejo ⁴, Ester Donat ⁵, Petra Riznik ², Maria Roca ⁶, Francesco Valitutti ⁷, Anne Veenvliet ⁸, M Luisa Mearin ⁹

Author information

¹Department of Pediatrics, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands. mwessels@rijnstate.nl.

²Department of Pediatrics, Gastroenterology, Hepatology and Nutrition Unit, University Medical Centre Maribor, Maribor, Slovenia.

³Department of Pediatrics, Medical Faculty, University Medical Centre Maribor, Maribor, Slovenia.

⁴Pediatric Gastroenterology Unit, Hospital Universitario Sant Joan de Reus, Reus, Spain.

⁵Pediatric Gastroenterology and Hepatology Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain.

⁶Celiac Disease and Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.

⁷Pediatric Unit, Salerno University Hospital, Salerno, Italy.

⁸Department of Pediatrics, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands.

⁹Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

Adequate follow-up in celiac disease is important to improve dietary compliance and treat disease-related symptoms and possible complications. However, data on the follow-up of celiac children is scarce. We aimed to assess current pediatric celiac follow-up practices across Europe. Pediatricians and pediatric gastroenterologists from 35 countries in Europe, Israel, Turkey, and Russia completed an anonymous survey which comprised a 52-item questionnaire developed by the ESPGHAN Special Interest Group on Celiac Disease. A total of 911 physicians, the majority of whom exclusively worked in pediatric care (83%) and academic institutions (60%), completed the questionnaire. Mean age and mean experience with celiac care were 48.7 years (± 10.6) and 15.7 years (± 9.9), respectively. The vast majority (≥ 92%) always assessed anthropometry, dietary adherence, and tissue-transglutaminase IgA-antibodies at every visit, with the first visit being between 3 and 6 months after diagnosis. Other parameters (% always tested) were as follows: complete blood count (60%), iron status (48%), liver enzymes (42%), thyroid function (38%), and vitamin D (26%). Quality of life was never assessed by 35% of the responding physicians. Transition to adult care was mostly completed via a written transition report (37%) or no formal transition at all (27%).Conclusions: Follow-up of celiac children and adolescents in Europe may be improved, especially regarding a more rational use of (laboratory) tests, dietary and QoL assessment, and transition to adult care. Evidence-based advice from international scientific societies is needed. What is Known: • Follow-up in celiac disease is important to treat disease-related symptoms, improve dietary compliance, and prevent possible complications. • There is a lack of consensus about the appropriate follow-up. What is New: • Almost all European physicians assess anthropometry, tissue-transglutaminase IgA-antibodies, and dietary adherence at every visit, but there are large variations in other follow-up aspects. • Follow-up could be improved by a more rational use of (laboratory) tests, increased intention to dietary compliance, and quality of life together with transition programs to adult care.