Screening for coeliac disease in preschool Greek children: the feasibility study of a community-based project

Area of Science:

• Paediatric gastroenterology
• Immunology
• Public health screening

Background:

• Coeliac disease (CD) is an autoimmune disorder triggered by gluten ingestion.
• Accurate prevalence data in paediatric populations is crucial for public health strategies.
• Early detection and diagnosis of CD in children can prevent long-term complications.

Purpose of the Study:

• To evaluate the prevalence of coeliac disease (CD) in the Greek paediatric population.
• To assess the feasibility and diagnostic accuracy of community-based screening for CD in preschool children.
• To establish a reliable protocol for identifying asymptomatic CD cases.

Main Methods:

• A two-part study involving a pilot screening of 1136 preschool children (aged 2-6 years) and a larger prevalence study using random clustered sampling.
• Nonmedical staff administered rapid immunochromatographic tests for tTG-IgA antibodies and IgA deficiency.
• Positive screening results were confirmed by paediatric gastroenterologists through serum antibody tests (anti-tTG IgA, EMA-IgA) and small bowel biopsies.

Main Results:

• The pilot study screened 1136 toddlers, revealing a prevalence of positive rapid anti-tTG screening at 1:154.
• The prevalence of IgA deficiency was found to be 1:120.
• Biopsy-proven coeliac disease prevalence was determined to be 1:154, informing sample size calculations for the main study.

Conclusions:

• A rapid immunochromatographic test protocol for detecting IgA deficiency and CD is effective and user-friendly for nonmedical staff in community settings.
• This approach enables accurate identification of new coeliac disease cases within an asymptomatic paediatric population.
• The study supports the implementation of community-based screening programs for early coeliac disease detection in children.