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Published on: December 15, 2011
Mass screening for coeliac disease using antihuman transglutaminase antibody assay
1Department of Reproductive and Development Science of Trieste University and I.R.C.C.S. Burlo Garofolo, Italy.
Insights
Coeliac disease is common in Italian schoolchildren, with many cases being asymptomatic. Mass screening is feasible, showing good acceptance and dietary compliance in a paediatric population.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Public Health
Background:
- Coeliac disease (CD) is an autoimmune disorder triggered by gluten ingestion.
- Early diagnosis and adherence to a gluten-free diet (GFD) are crucial for managing CD and preventing long-term complications.
- Screening in paediatric populations can identify undiagnosed cases.
Purpose of the Study:
- To determine the prevalence of coeliac disease in a large Italian paediatric cohort using anti-transglutaminase antibody assays.
- To evaluate the acceptance rate of a coeliac disease screening program among schoolchildren and their families.
- To assess dietary compliance and long-term health outcomes in diagnosed children.
Main Methods:
- A cross-sectional survey involving 3188 schoolchildren (aged 6-12) was conducted.
- Coeliac disease diagnosis was confirmed by intestinal biopsy or serological markers (anti-tissue transglutaminase and anti-endomysium antibodies) in HLA DQ2-8 positive subjects.
- Prospective follow-up assessed dietary compliance (anti-transglutaminase antibody negativity) and clinical/laboratory abnormalities at 24 months.
Main Results:
- The screening program achieved an 87% family consent rate.
- A coeliac disease prevalence of 1:106 (biopsy-proven) and 1:96 (including serological/HLA positive non-biopsied) was identified.
- Of 33 diagnosed cases, 12 were symptomatic; 71.4% of those on a GFD achieved serological normalization within 18-24 months, with symptom resolution in all symptomatic children.
Conclusions:
- Coeliac disease prevalence is significant in Italian schoolchildren, with a high proportion of asymptomatic cases.
- The screening program demonstrated good acceptance and effective dietary compliance.
- Population-based screening for coeliac disease in children warrants consideration due to its prevalence and potential complications.
Aims:
To determine coeliac disease prevalence by an anti-transglutaminase antibody assay in a large paediatric population; to evaluate acceptance of the screening programme, dietary compliance, and long term health effects.
Methods:
Cross-sectional survey of 3188 schoolchildren (aged 6-12) and prospective follow up of diagnosed cases. Main outcome measures were: prevalence of coeliac disease defined by intestinal biopsy or positivity to both human tissue transglutaminase and anti-endomysium antibodies in HLA DQ2-8 positive subjects; percentage of children whose families accepted screening; dietary compliance as defined by negativity for anti-transglutaminase antibodies; and presence of clinical or laboratory abnormalities at 24 month follow up.
Results:
The families of 3188/3665 children gave their consent (87%). Thirty biopsy proven coeliacs were identified (prevalence 1:106). Three other children testing positive for both coeliac related autoantibodies and HLA DQ2-8 but refusing biopsy were considered as having coeliac disease (prevalence 1:96). Of 33 cases, 12 had coeliac related symptoms. The 30 biopsy proven coeliacs followed a gluten-free diet. Of 28 subjects completing 18-24 months follow up, 20 (71.4%) were negative for anti-transglutaminase antibodies, while eight were slightly positive; symptoms resolved in all 12 symptomatic children.
Conclusions:
Prevalence of coeliac disease is high in Italian schoolchildren. Two thirds of cases were asymptomatic. Acceptance of the programme was good, as was dietary compliance. Given the high prevalence and possible complications of untreated coeliac disease, the availability of a valid screening method, and evidence of willingness to comply with dietary treatment population mass screening deserves careful consideration.
