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Population screening for coeliac disease in primary care by district nurses using a rapid antibody test: diagnostic
Ilma R Korponay-Szabó1, Katalin Szabados, Jánosné Pusztai
1Department of Paediatrics, Medical and Health Science Centre, University of Debrecen, 4032 Debrecen, Hungary.
Insights
Primary care nurses can screen children for coeliac disease using a rapid antibody test, improving early diagnosis. Further training is recommended to enhance the test's sensitivity for detecting this condition.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Primary Care Medicine
Background:
- Coeliac disease diagnosis often relies on specialized centers, potentially delaying identification in primary care settings.
- Early detection of coeliac disease is crucial for managing symptoms and preventing long-term complications.
Purpose of the Study:
- To assess the feasibility and diagnostic accuracy of rapid screening for coeliac disease using IgA antibodies to tissue transglutaminase in primary care.
- To evaluate the effectiveness of primary care nurses in performing rapid antibody tests for coeliac disease.
Main Methods:
- A cohort of 2690 six-year-old children in Hungary were screened by district nurses using a rapid finger-prick blood test for IgA antibodies to tissue transglutaminase.
- Laboratory tests for IgA and IgG antibodies to endomysium and tissue transglutaminase were performed, with biopsy confirming coeliac disease.
- Children with positive rapid tests were directly referred for small intestinal biopsy.
Main Results:
- Biopsy-confirmed coeliac disease was diagnosed in 37 children (1.4%), with only five previously identified clinically.
- The rapid test demonstrated 78.1% sensitivity and 100% specificity for biopsy-confirmed coeliac disease.
- The median time to biopsy was significantly shorter following a positive rapid test (20 days) compared to a positive laboratory result (142 days).
Conclusions:
- Rapid antibody testing in primary care, performed by nurses, is a feasible method for detecting undiagnosed coeliac disease in the community.
- The rapid test identified children with coeliac disease who were missed by routine clinical care.
- Additional training is necessary to improve the sensitivity of the rapid antibody test for coeliac disease screening.
Objective:
To evaluate the feasibility and diagnostic accuracy of screening for coeliac disease by rapid detection of IgA antibodies to tissue transglutaminase performed in primary care.
Design:
District nurses screened 6 year old children using rapid antibody testing of finger prick blood. They also collected capillary blood samples for laboratory determination of IgA and IgG antibodies to endomysium and IgA antibodies to tissue transglutaminase. Children with positive rapid test results were directly sent for biopsy of the small intestine. Setting Primary care in Jász-Nagykun-Szolnok county, Hungary.
Participants:
2690 children (77% of 6 year olds living in the county) and 120 nurses.
Main Outcome Measures:
Positivity for antibodies to endomysium or transglutaminase in the laboratory and coeliac disease confirmed at biopsy.
Results:
37 children (1.4%, 95% confidence interval 0.9% to 1.8%) had biopsy confirmed coeliac disease. Only five of these children had been diagnosed clinically before screening. Rapid testing had a 78.1% sensitivity (70.0% to 89.3%) and 100% specificity (88.4% to 100%) for a final diagnosis of coeliac disease by biopsy. Sensitivity was 65.1% (50.2% to 77.6%) and specificity was 100% (99.8% to 100%) compared with combined results of IgA and IgG laboratory tests. Trained laboratory workers detected 30 of the 31 newly diagnosed IgA competent patients with the rapid test kit used blindly. Median time to biopsy after a positive rapid test result was significantly shorter (20 days, range 4-148) than after a positive laboratory result (142 days, 70-256; P<0.001). Children with coeliac disease detected at screening were smaller and had worse health status than their peers but they improved on a gluten-free diet.
Conclusions:
A simple rapid antibody test enabled primary care nurses to detect patients with coeliac disease in the community who were not picked up in clinical care. Extra training is needed to improve sensitivity.
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