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Celiac Disease on the Bed-Side: Embedding Case Finding and Screening in Hospitalized Children
Angela Pepe1, Claudia Mandato1, Tiziana Di Leo2
1Pediatrics Section, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy.
Insights
Hospitalized children in Southern Italy show a celiac disease (CD) prevalence of 1.59%, similar to population screening programs. Testing during routine blood draws may improve diagnosis rates.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Public Health
Background:
- Celiac disease (CD) diagnosis relies on case-finding and population screening, with screening showing higher detection rates but remaining controversial.
- Global CD prevalence is approximately 1%, but screening programs can reveal nearly double this rate, particularly in school-aged children.
- This study investigates CD prevalence among hospitalized children in Southern Italy and associated clinical indicators.
Purpose of the Study:
- To estimate the prevalence of celiac disease (CD) in hospitalized pediatric patients.
- To determine the prevalence of celiac disease autoimmunity (CDA) within this cohort.
- To explore the frequency of clinical alerts related to malabsorption/malnutrition and systemic inflammation at diagnosis.
Main Methods:
- Retrospective analysis of inpatient pediatric records tested for anti-transglutaminase IgA antibodies (TGA-IgA).
- Diagnosis of CD followed 2012 or 2020 ESPGHAN guidelines.
- Celiac disease autoimmunity (CDA) was defined by elevated TGA-IgA, irrespective of biopsy or anti-endomysial antibody confirmation.
Main Results:
- Out of 3608 admitted pediatric patients, 1320 (36.6%) were screened for CD.
- The prevalence of newly diagnosed CD was 1.59% (21 patients), and CDA prevalence was 3.86% (51 subjects).
- Among diagnosed CD patients, 28.6% presented with underweight or malnutrition.
Conclusions:
- The prevalence of CD diagnoses in hospitalized children was comparable to population screening programs.
- The prevalence of CDA was notably higher than diagnosed CD.
- Routine CD testing during hospital admissions offers a cost-effective, non-invasive method to bridge the gap between case-finding and population screening.
Background:
Strategies for diagnosing celiac disease (CD) include case-finding and population-screening programs. Case finding consists of testing individuals at increased risk for the disease due to symptoms or associated conditions. Screening programs are widespread campaigns, which definitely perform better in terms of unveiling CD diagnoses but nowadays are still debatable. The global prevalence of CD is around 1% but it almost doubles when considering screening programs among school children. Within this framework, we aimed to estimate the prevalence of CD among hospitalized children in the Pediatric Department of a Southern Italy University Hospital in the period from January 2018 through December 2021. In addition, we attempted to explore, at the time of diagnosis, the prevalence of leading clinical alerts due to malabsorption/malnutrition such as anemia or failure to thrive or due to systemic inflammation/immune dysfunction as hypertransaminasemia and thyroid dysfunction.
Methods:
Data records of pediatric patients admitted as inpatients and tested by anti-transglutaminase IgA antibodies (TGA-IgA) were retrospectively analyzed. CD was diagnosed according to either 2012 or 2020 ESPGHAN guidelines, depending on the year of diagnosis. CD autoimmunity (CDA) was a wider group defined within our protocol if patients had elevated TGA-IgA on at least one occasion, regardless of anti-endomysial antibodies (EMA-IgA) and without biopsy confirmation.
Results:
During the observation period, 3608 pediatric patients were admitted and 1320 were screened for CD (median age 5 years, IQR 2-9 years; CD test rate: 36.6% out of all admissions). The available prevalence of newly diagnosed CD was 1.59% (21 patients diagnosed) and the available prevalence of CDA was 3.86% (51 subjects). Among CD patients, underweight/malnourished children accounted for 28.6% (6 out of 21).
Conclusions:
The estimated prevalence of CD diagnoses within our setting was comparable to the most recent population-screening programs. The estimated prevalence of CDA was even higher. A hospital-admission CD testing during routine blood draws might be a non-invasive, cost-effective and valuable approach to reduce discrepancy of prevalence between case-finding and population-screening programs.
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