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Coeliac Disease Case-Control Study: Has the Time Come to Explore beyond Patients at Risk?
Gemma Castillejo1, Carlos Ochoa-Sangrador2, David Pérez-Solís3
1Unitat de Recerca en Pediatria, Hospital Universitari Sant Joan de Reus, Nutrició i Desenvolupament Humà, IISPV, Universitat Rovira i Virgili, 43204 Reus, Spain.
Insights
Many children diagnosed with coeliac disease (CD) are asymptomatic but may present with non-specific symptoms. Expanding screening for CD in children could identify more cases and reduce long-term complications.
Area of Science:
- Pediatrics
- Gastroenterology
- Immunology
Background:
- The prevalence of asymptomatic coeliac disease (CD) is rising, partly due to targeted screening.
- Both symptomatic and asymptomatic CD patients face risks of long-term complications.
- Understanding clinical differences between asymptomatic and symptomatic pediatric CD is crucial.
Purpose of the Study:
- To compare clinical characteristics of asymptomatic versus symptomatic children diagnosed with coeliac disease.
- To evaluate differences in serology, genetics, and histopathology between the two groups.
Main Methods:
- A case-control study involving 468 asymptomatic and 468 symptomatic pediatric CD patients matched by age and sex.
- Data collected from 73 Spanish centers between 2011 and 2017.
- Analysis included clinical, serologic, genetic, and histopathologic data.
Main Results:
- No significant differences in most clinical variables or intestinal lesion severity were observed.
- Asymptomatic children were taller and less likely to have very high levels of anti-transglutaminase IgA antibodies.
- Among those not screened due to lack of risk factors, 66% reported non-specific CD-related symptoms.
Conclusions:
- Routine screening for coeliac disease (CD) in children, even without clear risk factors, may be beneficial.
- Many children labeled asymptomatic exhibit non-specific symptoms, suggesting broader screening could improve early detection.
- Expanding screening may reduce the burden of care by identifying CD earlier.
Abstract:
The worldwide prevalence of asymptomatic coeliac disease (CD) is increasing, which is in part due to the routine screening of children with risk factors. Both symptomatic and asymptomatic patients with CD are at risk of long-term complications. The objective of this study was to compare the clinical characteristics of asymptomatic and symptomatic children at the time of CD diagnosis. A case-control study was conducted using data from a cohort of 4838 CD patients recruited from 73 centers across Spain between 2011 and 2017. A total of 468 asymptomatic patients (cases) were selected and matched by age and sex with 468 symptomatic patients (controls). Clinical data, including any reported symptoms, as well as serologic, genetic, and histopathologic data were collected. No significant differences were found between the two groups in most clinical variables, nor in the degree of intestinal lesion. However, the asymptomatic patients were taller (height z-score -0.12 (1.06) vs. -0.45 (1.19), p < 0.001) and were less likely to have anti transglutaminase IgA antibodies ≥ 10 times the upper normal limit (66.2% vs. 758.4%, p = 0.002). Among the 37.1% of asymptomatic patients who were not screened for CD due to the absence of risk factors, only 34% were truly asymptomatic, while the remaining 66% reported non-specific CD-related symptoms. Therefore, expanding CD screening to any child who undergoes a blood test could reduce the burden of care for some children, as many of those considered asymptomatic reported non-specific CD-related symptoms.
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