In 2012 the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) has issued diagnostic guidelines for coeliac disease (CD) that should support physicians in accurately diagnosing CD without performing duodenal biopsies in selected patients. These guidelines have now been updated, new clinical evidence for this approach has been implemented and the non-biopsy approach has been evaluated also in asymptomatic children.
Differential diagnosis of bowel diseases can be challenging, because most of them present with similar common symptoms: abdominal pain and discomfort, diarrhea, weight loss. Infections by common gastrointestinal pathogens may soon be identified, but discrimination of inflammatory bowel disease, of which ulcerative colitis and Crohn’s disease are the most common, and irritable bowel syndrome, remains difficult.
Inflammatory bowel disease (IBD) is characterised by inflammation of the bowel, which is not seen in most patients with irritable bowel syndrome (IBS), and both conditions request different diagnostic and therapeutic approaches. IBD are serious diseases with severe comorbidities, and affected patients need further investigation with extensive diagnostic measures and intensive medical treatment. In contrast to that, IBS may be painful and impairs quality of life, but it does not usually cause serious morbidity. However, patients with IBS can have symptoms for many years and they often experience unnecessary and stressing diagnostic procedures.