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Celiac disease screening at a pediatric outpatient clinic: a feasibility study
Sunna Gunnarsdottir1, Henrik Albrektsson2, Julia Frydebo3
1Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden.
Insights
Non-targeted screening for celiac disease (CD) in pediatric clinics is feasible. Early diagnosis and treatment in children did not significantly alter well-being within one year, despite good dietary adherence.
Area of Science:
- Pediatric Gastroenterology
- Clinical Immunology
- Public Health Screening
Background:
- Celiac disease (CD) is common but often underdiagnosed.
- Screening in pediatric outpatient settings is under-explored.
Purpose of the Study:
- To assess the feasibility of non-targeted celiac disease screening in a pediatric outpatient setting.
- To evaluate the short-term impact of screening on children with serological evidence of disease.
Main Methods:
- 500 children (2-17 years) were surveyed and screened for tissue-transglutaminase antibodies (tTGA).
- Repeated tTGA positivity defined celiac disease autoimmunity (CDA).
- Children with CDA were investigated for CD and monitored for 1 year.
Main Results:
- 2.3% (11/481) of children had CDA, younger than those without CDA.
- 8 of 11 children with CDA were diagnosed with CD.
- Screening was well-accepted; diagnosed children showed no significant changes in symptoms or quality of life.
Conclusions:
- Non-targeted celiac disease screening is feasible in general pediatric outpatient settings.
- Symptoms do not reliably differentiate children with and without CDA.
- Diagnosing and treating CD in minimally symptomatic children did not significantly impact well-being in the short term.
Objectives:
Celiac disease (CD) is a common yet largely underdiagnosed disease. This study aimed to test the feasibility of incorporating a non-targeted CD screening in a pediatric outpatient setting and evaluate its short-term impact on children with serological evidence of disease.
Methods:
Over five months, 500 children (aged 2-17 years) attending a general pediatric outpatient clinic in Gothenburg, Sweden, were enrolled and surveyed for current symptoms, quality of life, and background characteristics; 481 children were screened for tissue-transglutaminase antibodies (tTGA); repeated tTGA-positivity was defined as CD autoimmunity (CDA). Children with CDA were investigated for CD and for one year monitored for changes in symptoms, and quality of life.
Results:
Eleven of 481 (2.3%) screened children had CDA. Children with CDA were younger (median 3.8 years) than those without CDA (8.8 years). No other major between-group differences were reported in background characteristics, symptoms, or quality of life. The screening was well-accepted by the families/participants. During 1-year follow-up, 8 of 11 children with CDA were diagnosed with CD. Children with screening-detected CD reported no significant changes in symptoms and quality of life and the dietary adherence rate was good.
Conclusions:
Non-targeted screening for CD was feasible in a general pediatric outpatient setting. While hampered by small sample size, our results are in line with previous screening studies indicating that symptoms do not differentiate CDA from non-CDA children. Also, among an overall minimal-symptomatic group of children, diagnosing CD and installation of treatment did not significantly change their well-being during 1-year follow-up.
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