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Opportunistic coeliac disease screening in undifferentiated presentations to paediatric acute care
Karrnan Pathmanandavel1, Melanie Wong1, Emma Williams1
1Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Insights
Screening for coeliac disease (CD) in pediatric emergency departments identified a 0.7% prevalence of confirmed CD. Testing tissue transglutaminase IgA in children over 10 may optimize screening for this condition.
Area of Science:
- Pediatric Gastroenterology
- Clinical Diagnostics
- Public Health Screening
Background:
- Coeliac disease (CD) often presents with atypical symptoms, leading to delayed diagnosis.
- Screening in emergency departments (ED) could identify undiagnosed cases in pediatric patients.
Purpose of the Study:
- To evaluate the feasibility and yield of screening for CD in undifferentiated pediatric patients presenting to an ED.
- To determine the prevalence of CD and identify optimal screening strategies in this setting.
Main Methods:
- Blood samples from pediatric ED patients were tested for tissue transglutaminase IgA (tTG IgA) and deamidated gliadin IgG (DGP IgG) antibodies.
- Positive results prompted counseling, confirmatory testing, and gastroenterology referral if necessary.
Main Results:
- An initial positive antibody result was observed in 4.2% of patients.
- Biopsy-confirmed CD prevalence was 0.7%, with higher rates (3.3%) in children over 10 years old.
- Factors like family history and symptoms such as abdominal pain were associated with persistent positive tests.
Conclusions:
- Opportunistic CD screening in the ED warrants further investigation.
- Testing tTG IgA and total IgA in children over 10 years old may be an optimal screening approach.
- Transiently positive coeliac antibodies could potentially predict future CD development.
Aim:
Coeliac disease (CD) can remain undiagnosed due to absent/atypical symptoms. We evaluated screening for CD in undifferentiated paediatric patients in the emergency department (ED).
Methods:
Subjects were all patients presenting to a children's hospital ED during the study period who had blood taken. Plasma remaining after routine care was tested for tissue transglutaminase IgA (tTG IgA) and deamidated gliadin IgG (DGP IgG) antibodies. Patients with positive results were counselled and offered confirmatory testing, then gastroenterology review if warranted.
Results:
An initial positive result for either DGP IgG or tTG IgA was found in 4.2% (44/1055). There was a normalisation of 76% (19/25) of positive DGP IgG and 44% (4/9) of tTG IgA results on repeat testing, which was not available in 27% (12/44). The prevalence of biopsy-confirmed CD was 0.7% (7/1055), including two new diagnoses and five subjects with known CD. Three likely cases could not be confirmed. All confirmed and likely cases were >10 years old. In children >10 years old, the prevalence of either biopsy-confirmed or likely CD was 3.3% (10/302). A family history of CD, growth concerns, recurrent abdominal pain and lethargy were associated with persistence of positive tests.
Conclusion:
Opportunistic testing for CD in ED requires further investigation as a CD screening strategy. Our results suggest optimal screening in this setting should be by initially testing for tTG IgA and total IgA in children >10 years old (minimising transiently positive tests). Transiently positive coeliac antibodies may also warrant further investigation as a predictor of future CD.
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