Celiac disease in Tunisian children: a second screening study using a "new generation" rapid test

Area of Science:

• Pediatric Gastroenterology
• Immunology
• Public Health

Background:

• Celiac disease diagnosis in children often faces delays, even with typical symptoms.
• Screening programs are essential for identifying undiagnosed cases in pediatric populations.

Purpose of the Study:

• To estimate celiac disease prevalence among schoolchildren on the island of Djerba, Tunisia.
• To assess the feasibility and acceptance of a rapid screening method for celiac disease and IgA deficiency.
• To evaluate the diagnostic yield of rapid versus conventional testing methods.

Main Methods:

• A rapid screening method for IgA anti-tissue transglutaminase and IgA deficiency was employed on 2064 schoolchildren.
• Positive cases underwent conventional serological testing (IgA anti-transglutaminase, anti-endomysium) and, where indicated, intestinal biopsy.
• IgA deficiency was confirmed using nephelometry, with IgG anti-endomysium testing performed in relevant cases.

Main Results:

• The rapid test identified 7 children; conventional serology confirmed all positive cases.
• Intestinal biopsy revealed total villous atrophy in 5 children, indicating celiac disease.
• The prevalence of celiac disease was estimated at 0.24-0.34%, and IgA deficiency at 0.5-0.6%.
• Silent celiac disease was diagnosed in 3 children, with other cases presenting with chronic diarrhea, growth failure, or borderline growth.

Conclusions:

• Celiac disease is relatively common in Tunisian schoolchildren, with a significant number escaping diagnosis despite symptoms.
• Rapid screening methods are a viable and well-accepted alternative to conventional blood tests, improving patient compliance.
• Early detection through effective screening is crucial for managing celiac disease and preventing long-term complications in children.