14a3f011e93dd0908c656a481dc0b29d 325960.pdf 02c618e6679bcc98b1234162a8363366464ec6cf 325960.pdf acc6f7bb6ca7405c2bc33cda9756c28840b7515d6974169208eb84a068262735 325960.pdf Title: Laboratory and Clinical Practices in the Study of Coeliac Disease in Children and Adults: Recommendations from a Spanish Multicentre Survey Subject: 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. Keywords: coeliac disease; autoimmune disorders; nutritional deficiencies; clinical laboratory diagnostics; RAND/UCLA method; health care surveys; clinical guidelines Author: Rocío Aguado, Juan Irure-Ventura, Maria Luisa Vargas, Garbiñe Roy, Yvelise Barrios, Laura Martínez-Martínez, Beatriz Rodríguez, Marco Antonio Montes, Marcos López-Hoyos and Aurora Jurado Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Wed Jun 18 14:44:09 2025 CEST ModDate: Wed Jun 18 14:47:04 2025 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 664828 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- EDOYQN+URWPalladioL-Roma Type 1 Custom yes yes yes 10 0 XXOGLX+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 YIEQVI+URWPalladioL-Ital Type 1 Custom yes yes yes 21 0 CCGMBL+CMSY10 Type 1 Builtin yes yes yes 50 0 KJEPGP+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 64 0 KJEPHP+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 70 0 KJEPJA+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 76 0 KJEPGP+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 89 0 KJEPHP+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 95 0 KJEPJA+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 101 0 KJEPGP+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 135 0 KJEPHP+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 141 0 KJEPJA+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 147 0 DFTOOC+VnURWPalladioL Type 1 Custom yes yes yes 181 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-03-05 04:19:49 CET RepresentationInformation: 325960.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-03-04 12:50:52 CET Size: 664828 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 323 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Study Design, Settings, and Participants Destination: subsection.2.1 Item: Title: Survey Destination: subsection.2.2 Item: Title: Statistical Analysis Destination: subsection.2.3 Item: Title: Results Destination: section.3 Children: Item: Title: Diagnostic Questions Regarding Coeliac Disease in the General Population Destination: subsection.3.1 Item: Title: Survey Questions Addressing the Diagnosis of Coeliac Disease in At-Risk Groups Destination: subsection.3.2 Item: Title: Survey Questions Regarding Follow-Ups for Coeliac Disease Patients Destination: subsection.3.3 Item: Title: Questions Addressing Demand Management for Tests Destination: subsection.3.4 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: Laboratory and Clinical Practices in the Study of Coeliac Disease in Children and Adults: Recommendations from a Spanish Multicentre Survey Author: Rocío Aguado, Juan Irure-Ventura, Maria Luisa Vargas, Garbiñe Roy, Yvelise Barrios, Laura Martínez-Martínez, Beatriz Rodríguez, Marco Antonio Montes, Marcos López-Hoyos and Aurora Jurado Subject: 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. Keywords: coeliac disease; autoimmune disorders; nutritional deficiencies; clinical laboratory diagnostics; RAND/UCLA method; health care surveys; clinical guidelines Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Wed Jun 18 14:44:09 CEST 2025 ModDate: Wed Jun 18 14:47:04 CEST 2025 ID: 0x86cca60a63b8e8f8ad63eac24c616795, 0x86cca60a63b8e8f8ad63eac24c616795 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: XXOGLX+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 243 FontDescriptor: FontName: XXOGLX+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: CCGMBL+CMSY10 FontSubset: true FirstChar: 2 LastChar: 21 FontDescriptor: FontName: CCGMBL+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true ToUnicode: true Font: BaseFont: YIEQVI+URWPalladioL-Ital FontSubset: true FirstChar: 39 LastChar: 150 FontDescriptor: FontName: YIEQVI+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: DFTOOC+VnURWPalladioL FontSubset: true FirstChar: 157 LastChar: 157 FontDescriptor: FontName: DFTOOC+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: EDOYQN+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 250 FontDescriptor: FontName: EDOYQN+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 54, 177, 152, 186 Annotation: Subtype: Link Rect: 34, 167, 72, 174 Annotation: Subtype: Link Rect: 36, 75, 152, 84 Annotation: Subtype: Link Rect: 34, 63, 89, 72 Annotation: Subtype: Link Rect: 34, 773, 141, 809 Annotation: Subtype: Link Rect: 515, 773, 560, 809 Annotation: Subtype: Link Rect: 112, 643, 123, 656 Annotation: Subtype: Link Rect: 232, 643, 243, 656 Annotation: Subtype: Link Rect: 340, 643, 352, 656 Annotation: Subtype: Link Rect: 499, 643, 510, 656 Annotation: Subtype: Link Rect: 156, 629, 167, 642 Annotation: Subtype: Link Rect: 259, 629, 270, 642 Annotation: Subtype: Link Rect: 540, 629, 552, 642 Annotation: Subtype: Link Rect: 126, 615, 137, 628 Annotation: Subtype: Link Rect: 426, 27, 560, 37 Annotation: Subtype: Link Rect: 34, 391, 87, 410 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 397, 605, 404, 614 ActionDest: 178 Annotation: Subtype: Link Rect: 407, 605, 414, 614 ActionDest: 178 Annotation: Subtype: Link Rect: 460, 550, 467, 558 ActionDest: 178 Annotation: Subtype: Link Rect: 468, 549, 475, 558 ActionDest: 178 Annotation: Subtype: Link Rect: 483, 521, 490, 531 ActionDest: 178 Annotation: Subtype: Link Rect: 491, 521, 503, 531 ActionDest: 178 Annotation: Subtype: Link Rect: 510, 494, 522, 503 ActionDest: 178 Annotation: Subtype: Link Rect: 525, 494, 537, 503 ActionDest: 178 Annotation: Subtype: Link Rect: 198, 480, 210, 489 ActionDest: 178 Annotation: Subtype: Link Rect: 213, 480, 225, 489 ActionDest: 178 Annotation: Subtype: Link Rect: 449, 410, 456, 419 ActionDest: 178 Annotation: Subtype: Link Rect: 457, 410, 469, 419 ActionDest: 178 Annotation: Subtype: Link Rect: 469, 410, 481, 419 ActionDest: 178 Annotation: Subtype: Link Rect: 306, 341, 318, 350 ActionDest: 178 Annotation: Subtype: Link Rect: 387, 187, 394, 196 ActionDest: 178 Annotation: Subtype: Link Rect: 395, 187, 407, 196 ActionDest: 178 Annotation: Subtype: Link Rect: 205, 114, 217, 123 ActionDest: 187 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 203, 717, 210, 726 ActionDest: 178 Annotation: Subtype: Link Rect: 427, 689, 434, 698 ActionDest: 178 Annotation: Subtype: Link Rect: 240, 520, 247, 532 ActionDest: 47 Page: Sequence: 4 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 438, 571, 445, 580 ActionDest: 178 Annotation: Subtype: Link Rect: 343, 557, 350, 566 ActionDest: 178 Annotation: Subtype: Link Rect: 408, 402, 415, 414 ActionDest: 58 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 541, 683, 548, 695 ActionDest: 83 Annotation: Subtype: Link Rect: 235, 600, 242, 612 ActionDest: 83 Annotation: Subtype: Link Rect: 487, 236, 494, 248 ActionDest: 129 Annotation: Subtype: Link Rect: 256, 180, 263, 192 ActionDest: 129 Annotation: Subtype: Link Rect: 401, 111, 408, 123 ActionDest: 129 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 199, 342, 206, 354 ActionDest: 129 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 386, 242, 393, 251 ActionDest: 178 Annotation: Subtype: Link Rect: 394, 242, 401, 251 ActionDest: 178 Annotation: Subtype: Link Rect: 434, 186, 446, 195 ActionDest: 187 Annotation: Subtype: Link Rect: 448, 102, 460, 111 ActionDest: 187 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 436, 730, 447, 740 ActionDest: 178 Annotation: Subtype: Link Rect: 247, 703, 254, 712 ActionDest: 178 Annotation: Subtype: Link Rect: 474, 647, 480, 656 ActionDest: 178 Annotation: Subtype: Link Rect: 481, 647, 493, 656 ActionDest: 178 Annotation: Subtype: Link Rect: 493, 647, 505, 656 ActionDest: 178 Annotation: Subtype: Link Rect: 506, 647, 518, 656 ActionDest: 187 Annotation: Subtype: Link Rect: 412, 605, 419, 614 ActionDest: 178 Annotation: Subtype: Link Rect: 419, 605, 426, 614 ActionDest: 178 Annotation: Subtype: Link Rect: 427, 605, 439, 614 ActionDest: 178 Annotation: Subtype: Link Rect: 439, 605, 451, 614 ActionDest: 178 Annotation: Subtype: Link Rect: 452, 605, 464, 614 ActionDest: 187 Annotation: Subtype: Link Rect: 216, 480, 228, 489 ActionDest: 187 Annotation: Subtype: Link Rect: 544, 285, 556, 294 ActionDest: 187 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 353, 675, 360, 684 ActionDest: 178 Annotation: Subtype: Link Rect: 361, 675, 373, 684 ActionDest: 187 Annotation: Subtype: Link Rect: 373, 675, 385, 684 ActionDest: 187 Annotation: Subtype: Link Rect: 394, 633, 406, 642 ActionDest: 187 Annotation: Subtype: Link Rect: 544, 591, 556, 600 ActionDest: 187 Annotation: Subtype: Link Rect: 544, 549, 556, 559 ActionDest: 187 Annotation: Subtype: Link Rect: 289, 522, 301, 531 ActionDest: 187 Annotation: Subtype: Link Rect: 302, 522, 314, 531 ActionDest: 187 Annotation: Subtype: Link Rect: 437, 341, 449, 350 ActionDest: 178 Annotation: Subtype: Link Rect: 452, 341, 464, 350 ActionDest: 178 Annotation: Subtype: Link Rect: 465, 341, 477, 350 ActionDest: 187 Annotation: Subtype: Link Rect: 480, 341, 492, 350 ActionDest: 187 Page: Sequence: 11 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 156, 716, 193, 726 Annotation: Subtype: Link Rect: 199, 716, 235, 726 Annotation: Subtype: Link Rect: 390, 689, 428, 700 Annotation: Subtype: Link Rect: 434, 689, 470, 700 Annotation: Subtype: Link Rect: 354, 664, 391, 675 Annotation: Subtype: Link Rect: 430, 638, 468, 649 Annotation: Subtype: Link Rect: 474, 638, 510, 649 Annotation: Subtype: Link Rect: 446, 613, 484, 624 Annotation: Subtype: Link Rect: 264, 574, 301, 585 Annotation: Subtype: Link Rect: 304, 537, 341, 547 Annotation: Subtype: Link Rect: 435, 523, 560, 536 Annotation: Subtype: Link Rect: 56, 510, 405, 521 Annotation: Subtype: Link Rect: 301, 473, 339, 483 Annotation: Subtype: Link Rect: 207, 435, 245, 445 Annotation: Subtype: Link Rect: 317, 408, 354, 419 Annotation: Subtype: Link Rect: 223, 384, 261, 394 Annotation: Subtype: Link Rect: 267, 384, 303, 394 Annotation: Subtype: Link Rect: 302, 345, 340, 356 Annotation: Subtype: Link Rect: 346, 345, 382, 356 Annotation: Subtype: Link Rect: 314, 319, 352, 330 Annotation: Subtype: Link Rect: 358, 319, 394, 330 Annotation: Subtype: Link Rect: 218, 281, 256, 292 Annotation: Subtype: Link Rect: 516, 255, 554, 266 Annotation: Subtype: Link Rect: 442, 191, 480, 202 Annotation: Subtype: Link Rect: 477, 153, 514, 164 Annotation: Subtype: Link Rect: 521, 153, 557, 164 Annotation: Subtype: Link Rect: 59, 141, 126, 151 Annotation: Subtype: Link Rect: 257, 102, 295, 113 Annotation: Subtype: Link Rect: 301, 102, 337, 113 Annotation: Subtype: Link Rect: 377, 77, 415, 87 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 305, 718, 342, 729 Annotation: Subtype: Link Rect: 349, 718, 385, 729 Annotation: Subtype: Link Rect: 392, 692, 429, 703 Annotation: Subtype: Link Rect: 436, 692, 472, 703 Annotation: Subtype: Link Rect: 299, 667, 337, 678 Annotation: Subtype: Link Rect: 343, 667, 379, 678 Annotation: Subtype: Link Rect: 269, 641, 307, 652 Annotation: Subtype: Link Rect: 450, 628, 488, 639 Annotation: Subtype: Link Rect: 278, 578, 315, 588 Annotation: Subtype: Link Rect: 230, 514, 268, 524 Annotation: Subtype: Link Rect: 384, 488, 421, 499 Checksum: 6b145fae Type: CRC32 Checksum: 14a3f011e93dd0908c656a481dc0b29d Type: MD5 Checksum: 02c618e6679bcc98b1234162a8363366464ec6cf Type: SHA-1 Checksum: acc6f7bb6ca7405c2bc33cda9756c28840b7515d6974169208eb84a068262735 Type: SHA-256