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Serological screening for celiac disease in symptomatic 12 to 36 month-old children
Inês Cristina Modelli1, Lenora Gandolfi, Rodrigo Coutinho de Almeida
1Graduate Program in Health Sciences, University of Brasilia School of Health Sciences, Brasilia, DF, Brazil.
Insights
Celiac disease affects 2.3% of young children with symptoms like diarrhea and failure to thrive. Diagnosis in this group is challenging, but serological tests and genetic analysis aid in identifying the condition.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Genetics
Background:
- Diagnosing celiac disease in young children is difficult due to overlapping symptoms with malnutrition and diarrhea.
- Environmental factors and other conditions can mimic celiac disease symptoms in children.
Purpose of the Study:
- To determine the prevalence of celiac disease in children aged 12-36 months.
- To evaluate the effectiveness of serological screening methods including immunoglobulin antibodies against gliadin (IgG and IgA-AGA), IgA-EMA, and IgA-tTG.
Main Methods:
- 214 children (12-36 months) on a gluten-containing diet were screened using IgG/IgA-AGA, IgA-tTG, and IgA-EMA tests.
- Biopsies were performed on children with positive serological results; HLA genotyping was used for confirmation and in ambiguous cases.
- Polymerase chain reaction (PCR) HLA genotyping identified celiac disease predisposing alleles.
Main Results:
- Five children were diagnosed with celiac disease based on positive serological tests and characteristic jejunal biopsy findings.
- IgG-AGA alone was insufficient for diagnosis, but combined with HLA genotyping and biopsy, it contributed to identifying cases.
- A prevalence of 2.3% was identified in the studied cohort of symptomatic, undiagnosed children.
Conclusions:
- Celiac disease can be diagnosed in symptomatic young children using a combination of serological tests and genetic analysis.
- The study highlights the importance of comprehensive diagnostic approaches for celiac disease in pediatric populations.
- A 2.3% prevalence underscores the need for awareness and screening in this age group.
Context:
The correct diagnosis of celiac disease in environmentally deprived children is frequently hindered by the common presence of other causes for the classical celiac disease symptoms: malnutrition, failure to thrive and frequent diarrheas.
Objectives:
To determine the prevalence of celiac disease in a group of 12 to 36 month-old children using immunoglobulin antibodies against gliadin (IgG and IgA-AGA), against endomysium (IgA-EMA), and against human tissue transglutaminase (IgA-tTG) as screening method.
Methods:
A total of 214 children (114 boys), aged 12 to 36 months, on gluten-containing diet, were admitted to the study. IgG and IgA-AGA, IgA-tTG and IgA-EMA tests were performed in all sera. Biopsy was obtained from all children showing positive result in one or more of the serologic tests, excluding those in which IgG-AGA had been the only positive result. In those cases, polymerase chain reaction (PCR) HLA genotyping for the identification of celiac disease predisposing alleles was applied. HLA genotyping was also performed to confirm the diagnosis in children identified as celiac by means of positive serologic testing and compatible biopsy results.
Results:
Normal results were obtained in 131 children. Ten children out of 68 identified as positive exclusively on the IgG-AGA test disclosed the presence of celiac disease predisposing alleles on PCR and underwent jejunal biopsy with normal results. All serologic tests were positive in four children. A fifth child showed positive IgG and IgA-AGA and IgA-tTG results but disclosed a negative IgA-EMA test. Jejunal biopsy of these five children revealed characteristic lesions of celiac disease.
Conclusion:
A prevalence of 2.3% was found among symptomatic 12- to 36-month-old children that had not been previously diagnosed as celiac.
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