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Transition from childhood to adulthood in coeliac disease: the Prague consensus report
  1. Jonas F Ludvigsson1,2,3,
  2. Lars Agreus4,
  3. Carolina Ciacci5,
  4. Sheila E Crowe6,
  5. Marilyn G Geller7,
  6. Peter H R Green8,
  7. Ivor Hill9,
  8. A Pali Hungin10,
  9. Sibylle Koletzko11,
  10. Tunde Koltai12,
  11. Knut E A Lundin13,
  12. M Luisa Mearin14,
  13. Joseph A Murray15,
  14. Norelle Reilly16,
  15. Marjorie M Walker17,
  16. David S Sanders18,
  17. Raanan Shamir19,
  18. Riccardo Troncone20,
  19. Steffen Husby21
  1. 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
  3. 3Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
  4. 4Division of Family Medicine, Karolinska Institutet, Sweden
  5. 5Department of Medicine and Surgery, University of Salerno, Salerno, Italy
  6. 6University of California, San Diego (UCSD), San Diego, California, USA
  7. 7Celiac Disease Foundation, Los Angeles, California, USA
  8. 8Celiac Disease Center at Columbia University, New York, New York, USA
  9. 9Division of Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio, USA
  10. 10Primary Care and General Practice, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
  11. 11Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany
  12. 12Hungary (for the Association of European Coeliac Societies, AOECS), Budapest, Hungary
  13. 13Department of Gastroenterology and Centre for Immune Regulation, Oslo University Hospital Rikshospitalet, Oslo, Norway
  14. 14Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
  15. 15Division of Gastroenterology and Hepatology, Department of Immunology Mayo Clinic, Rochester, Minnesota, USA
  16. 16Columbia University Medical Center-Division of Paediatric Gastroenterology, New York, New York, USA
  17. 17Anatomical Pathology, Faculty of Health and Medicine, University of Newcastle, School of Medicine & Public Health, Newcastle, Australia
  18. 18Academic Unit of Gastroenterology, Royal Hallamshire Hospital & University of Sheffield, Sheffield, UK
  19. 19Institute of Gastroenterology, Nutrition and Liver Diseases Schneider Children's Medical Center of Israel, Tel-Aviv University, Tel Aviv, Israel
  20. 20Department of Medical Translational Sciences & European Laboratory for the Investigation of Food Induced Diseases, University Federico II, Naples, Italy
  21. 21Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
  1. Correspondence to Dr Jonas F Ludvigsson, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden; jonasludvigsson{at} Dr Steffen Husby, Hans Christian Andersen Children's Hospital, Odense University Hospital, DK-5000 Odense, Denmark; Steffen.Husby{at}


The process of transition from childhood to adulthood is characterised by physical, mental and psychosocial development. Data on the transition and transfer of care in adolescents/young adults with coeliac disease (CD) are scarce. In this paper, 17 physicians from 10 countries (Sweden, Italy, the USA, Germany, Norway, the Netherlands, Australia, Britain, Israel and Denmark) and two representatives from patient organisations (Association of European Coeliac Societies and the US Celiac Disease Foundation) examined the literature on transition from childhood to adulthood in CD. Medline (Ovid) and EMBASE were searched between 1900 and September 2015. Evidence in retrieved reports was evaluated using the Grading of Recommendation Assessment, Development and Evaluation method. The current consensus report aims to help healthcare personnel manage CD in the adolescent and young adult and provide optimal care and transition into adult healthcare for patients with this disease. In adolescence, patients with CD should gradually assume exclusive responsibility for their care, although parental support is still important. Dietary adherence and consequences of non-adherence should be discussed during transition. In most adolescents and young adults, routine small intestinal biopsy is not needed to reconfirm a childhood diagnosis of CD based on European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) or North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) criteria, but a biopsy may be considered where paediatric diagnostic criteria have not been fulfilled, such as, in a patient without biopsy at diagnosis, additional serology (endomysium antibody) has not been performed to confirm 10-fold positivity of tissue transglutaminase antibodies or when a no biopsy strategy has been adopted in an asymptomatic child.


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