At-Risk Screened Children with Celiac Disease are Comparable in Disease Severity and Dietary Adherence to Those Found because of Clinical Suspicion: A Large Cohort Study

• Published in: The Journal of pediatrics Vol. 183; pp. 115 - 121.e2
• Main Authors: Kivelä, Laura, MD, Kaukinen, Katri, MD, PhD, Huhtala, Heini, MSc, Lähdeaho, Marja-Leena, MD, PhD, Mäki, Markku, MD, PhD, Kurppa, Kalle, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017
• Subjects: Adolescent; celiac antibodies; Celiac Disease - diagnosis; Celiac Disease - diet therapy; Celiac Disease - epidemiology; Child; Child, Preschool; clinical presentation; Cohort Studies; Databases, Factual; Diet, Gluten-Free - statistics & numerical data; Female; follow-up; Follow-Up Studies; gluten-free diet; Humans; Male; Mass Screening - methods; Patient Compliance - statistics & numerical data; Pediatrics; Predictive Value of Tests; Quality of Life; Retrospective Studies; Risk Assessment; screening; Severity of Illness Index; symptoms; Treatment Outcome; villous atrophy; T1DM; TG2ab; Reference value; screening; gluten-free diet; Endomysial antibody; Transglutaminase 2 antibody; celiac antibodies; symptoms; villous atrophy; follow-up; clinical presentation; Rf; EmA; Type 1 diabetes mellitus
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2016.12.077

Objective To assess whether children at risk for celiac disease should be screened systematically by comparing their baseline and follow-up characteristics to patients detected because of clinical suspicion. Study design Five hundred four children with celiac disease were divided into screen-detected (n = 145) and clinically detected cohorts (n = 359). The groups were compared for clinical, serologic, and histologic characteristics and laboratory values. Follow-up data regarding adherence and response to gluten-free diet were compared. Subgroup analyses were made between asymptomatic and symptomatic screen-detected patients. Results Of screen-detected patients, 51.8% had symptoms at diagnosis, although these were milder than in clinically detected children ( P  < .001). Anemia (7.1% vs 22.9%, P  < .001) and poor growth (15.7% vs 36.9%, P  < .001) were more common, and hemoglobin (126 g/l vs 124 g/l, P  = .008) and albumin (41.0 g/l vs 38.0 g/l, P  = .016) were lower in clinically detected patients. There were no differences in serology or histology between the groups. Screen-detected children had better dietary adherence (91.2% vs 83.2%, P  = .047). The groups showed equal clinical response (97.5% vs 96.2%, P  = .766) to the gluten-free diet. In subgroup analysis among screen-detected children, asymptomatic patients were older than symptomatic (9.0  vs 5.8 years of age, P  = .007), but the groups were comparable in other variables. Conclusions More than one-half of the screen-detected patients with celiac disease had symptoms unrecognized at diagnosis. The severity of histologic damage, antibody levels, dietary adherence, and response to treatment in screen-detected cases is comparable with those detected on a clinical basis. The results support active screening for celiac disease among at-risk children.