The environmental impact of pediatric celiac disease diagnosis and follow-up.

Objectives: To evaluate carbon dioxide (CO₂) footprint of celiac disease (CeD) diagnostic guidelines and follow-up practices for children/adolescents.

Methods: Two-hundred and thirty-six patients diagnosed and followed up for CeD in Umbria region during 2020-2023 were included in this retrospective study. Patients were divided in two groups: Group 1 included patients diagnosed by duodenal biopsies (total: 43), while Group 2 included no-biopsy patients (total: 193). Transport emissions of CO₂ per kilometer traveled by a diesel car was estimated as 171 g/km. CO₂ cost was estimated as 22 kg for each anesthesia and as 5.4 kg for each upper GI endoscopy.

Results: The median CO₂ cost/patient/year in Group 1 was 397.9 kg, while the median CO₂ cost/patient/year in Group 2 was 57.2 kg (p < 0.001). As regards the follow-up of these children, we estimated a median CO₂ amount of 39.3 kg produced per year by car emission and there was no difference between the two groups (Group 1 40.5 kg vs. Group 2 38.1 kg; p:ns).

Conclusions: The no-biopsy approach for the CeD diagnosis strongly decreases the CO₂ emissions. Whether implementing telemedicine, handing over to primary care or reducing outpatient consultations for follow-up will be feasible and environmentally more sustainable should be evaluated.