Impact of mass screening for gluten-sensitive enteropathy in working population

• Published in: World journal of gastroenterology : WJG Vol. 15; no. 11; pp. 1331 - 1338
• Main Authors: Mariné, Meritxell, Fernández-Bañares, Fernando, Alsina, Montserrat, Farré, Carme, Cortijo, Montserrat, Santaolalla, Rebeca, Salas, Antonio, Tomàs, Margarita, Abugattas, Elias, Loras, Carme, Ordás, Ingrid, Viver, Josep M, Esteve, Maria
• Format: Journal Article
• Language: English
• Published: United States Department of Gastroenterology,University Hospital of Mútua de Terrassa,Research Foundation Mútua de Terrassa,University of Barcelona,08221 Terrassa,Catalonia,Spain%Department of Immunology (Catlab),University Hospital of Mútua de Terrassa,Research Foundation Mútua de Terrassa,University of Barcelona,08221 Terrassa,Catalonia,Spain%Department of Biochemistry,Sant Joan de Déu Hospital,Esplugues,08950 Catalonia,Spain%Occupational Health Department,Egarsat (Prevention Society),Sant Cugat del Vallès,08173 Catalonia,Spain%Department of Pathology,University Hospital of Mútua de Terrassa,Research Foundation Mútua de Terrassa,University of Barcelona,08221 Terrassa,Catalonia,Spain 21.03.2009; The WJG Press and Baishideng
• Subjects: Atrophy; Biopsy; Celiac Disease - epidemiology; Celiac Disease - genetics; Celiac Disease - immunology; Celiac Disease - pathology; Duodenum - immunology; Duodenum - pathology; EMA; Follow-Up Studies; Genetic Markers; GSE; HLA-DQ Antigens - genetics; HLA-DQ Antigens - immunology; Humans; Immunoglobulin A - blood; Intestinal Mucosa - pathology; Intestinal Mucosa - physiopathology; Mass Screening - methods; Occupational Health Services - statistics & numerical data; Original; Polymerase Chain Reaction; Spain - epidemiology; Surveys and Questionnaires; Transglutaminases - immunology; 临床意义; 卫生部门; 总人口; 检查程序; Spain; Celiac disease; Lymphocytic enteritis; Mass screening; Antitransglutaminase and antiendomysium antibodies
• ISSN: 1007-9327; 2219-2840; 2219-2840
• DOI: 10.3748/wjg.15.1331

AIM： TO assess： （1） frequency and clinical relevance of gluten sensitive enteropathy （GSE） detected by serology in a mass screening program; （2） sensitivity of antitransglutaminase （tTGA） and antiendomysium antibodies （EmA）; and （3） adherence to gluten-free diet （GFD） and follow-up. METHODS： One thousand, eight hundred and sixty-eight subjects recruited from an occupational health department underwent analysis for tTGA and EmA and, if positive, duodenal biopsy, DQ2/DQ8 genotyping, clinical feature recording, blood tests, and densitometry were performed. Since 〉 98% of individuals had tTGA 〈 2 U/mL, this value was established as the cut-off limit of normality and was considered positive when confirmed twice in the same sample. Adherence to a GFD and follow up were registered. RESULTS： Twenty-six （1.39%） subjects had positive tTGA and/or EmA, and 21 underwent biopsy： six Marsh Ⅲ （one Ⅲa, four Ⅲb, one Ⅲc）, nine Marsh Ⅰ and six Marsh 0 （frequency of GSE 1：125）. The sensitivity of EmA for GSE was 46.6% （11.1% for Marsh Ⅰ, 100% for Marsh Ⅲ）, while for tTGA, it was 93.3% （88.8% for Marsh Ⅰ, 100% for Marsh Ⅲ）. All 15 patients with abnormal histology had clinical features related to GSE. Marsh Ⅰ and Ⅲ subjects had more abdominal pain than Marsh 0 （P = 0.029）, and a similar trend was observed for distension and diarrhea. No differences in the percentage of osteopenia were found between Marsh Ⅰ and Ⅲ （P = 0.608）. Adherence to follow-up was 69.2%. Of 15 GSE patients, 66.7% followed a GFD with 80% responding to it. CONCLUSION： GSE in the general population is frequent and clinically relevant, irrespective of histological severity, tTGA is the marker of choice. Mass screening programs are useful in identifying patients who can benefit from GFD and follow-up.