Clinical and diagnostic aspects of gluten related disorders

Table 1 Populations at risk for celiac disease, in which investigations for celiac disease are indicated, according to the most recent guidelines proposed by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and American College of Gastroenterology

ESPGHAN	NASPGHAN	ACG
Test children/adolescent with:	Test children/adolescent with:	Test patients with:
Chronic or intermittent diarrhoea, growth failure, weight loss	diarrhea and failure to thrive	chronic diarrhea with weight loss
Chronic abdominal pain, cramping or distension, nausea or vomiting, chronic constipation	abdominal pain, anorexia, constipation, vomiting	post-prandial abdominal pain, bloating
Short stature, delayed puberty	short stature, delayed puberty	other symptoms/signs suspect for CD
dermatitis herpetiformis–type rash	dermatitis herpetiformis
unexplained abnormal liver biochemistry		unexplained abnormal liver biochemistry
Iron-deficiency anaemia	Iron-deficient anaemia resistant to oral iron	other laboratory signs suspect for CD
repetitive fractures/osteopenia/osteoporosis	osteoporosis
chronic fatigue, ameorrhoea, recurrent aphthous stomatitis	Dental enamel hypoplasia of permanent teeth
First- degree family members	First-degree family members	First- degree family members
Type 1-diabetes mellitus	Type 1-diabetes mellitus	Type 1-diabetes mellitus
Other associated conditions1	Other associated conditions1

¹Down syndrome, autoimmune thyroid disease, Turner syndrome, Williams syndrome, IgA deficiency. ESPGHAN guidelines also consider autoimmune liver diseases. CD: Celiac disease; ESPGHAN: European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; NASPGHAN: North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition; ACG: American College of Gastroenterology.