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One-Year Outcomes Among Children Identified With Celiac Disease Through a Mass Screening Program
Marisa G Stahl1, Zhaoxing Pan2, Monique Germone1
1Digestive Health Institute, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Insights
Mass screening for celiac disease (CD) in children shows significant benefits. Early diagnosis through screening led to improved symptoms, quality of life, and normalized iron deficiency in pediatric CD patients.
Area of Science:
- Pediatric gastroenterology
- Autoimmune disease screening
- Public health initiatives
Background:
- Celiac disease (CD) mass screening is debated due to limited evidence of benefit.
- The Autoimmunity Screening for Kids (ASK) study aimed to evaluate mass screening for pediatric CD and type 1 diabetes in Colorado.
Purpose of the Study:
- To assess the benefits of mass screening for celiac disease in children.
- To evaluate clinical outcomes, quality of life, and adherence to a gluten-free diet in children diagnosed with CD through screening.
Main Methods:
- Prospective follow-up of children (ages 1-17) who screened positive for tissue transglutaminase IgA autoantibodies.
- Inclusion criteria: CD diagnosis by biopsy or serology.
- Evaluations included demographics, labs, symptoms, quality of life, anxiety/depression, and gluten-free diet adherence at baseline and 12-month follow-up.
Main Results:
- Of 52 enrolled children, 42 completed 12-month follow-up.
- Significant improvement in CD symptom severity and frequency scores (P < .001).
- Improved health-related quality of life scores reported by caregivers (P = .002).
- Common iron deficiency without anemia at baseline normalized in over half by follow-up.
- High gluten-free diet adherence (good or excellent) reported by 26 of 28 families.
Conclusions:
- Mass screening for celiac disease in children can identify affected individuals.
- Screening facilitates early diagnosis, leading to improved symptoms, quality of life, and resolution of iron deficiency.
- Findings suggest a potential benefit of mass screening programs for pediatric celiac disease.
Background & Aims:
Celiac disease (CD) mass screening remains controversial in part because of a paucity of data to support its benefit. The Autoimmunity Screening for Kids study is a mass screening study for pediatric CD and type 1 diabetes in Colorado.
Methods:
This study prospectively follows up children ages 1 to 17 years who screened positive for tissue transglutaminase IgA autoantibodies in the Autoimmunity Screening for Kids study subsequently referred for diagnostic evaluation. Children diagnosed with CD by biopsy or serologic criteria were included in this study. Evaluation at baseline and 12 month follow-up evaluation included demographics, laboratory studies, symptoms, health-related quality of life, anxiety/depression, and gluten-free diet adherence. Paired Student t test, chi-square, and Wilcoxon signed-rank tests compared baseline and follow-up data. For symptom scores, odds of improvement were assessed.
Results:
Of the 52 children with CD enrolled, 42 children completed 12-month follow-up evaluation. On the symptom questionnaire completed at diagnostic evaluation, 38 of 42 children reported 1 or more symptoms. CD mean symptom severity and frequency scores improved from baseline to follow-up evaluation (P < .001). Reported health-related quality of life scores improved among caregivers (P = .002). There was no significant change in reported anxiety or depression. Iron deficiency without anemia was common at baseline (21 of 24 children; 87.5%) and normalized at follow-up evaluation (11 of 21 children; 52.3%). Twenty-six of 28 families reported good or excellent gluten-free diet adherence.
Conclusions:
This novel study of children with CD identified through a mass screening program demonstrated improvement in symptoms, quality of life, and iron deficiency after 1 year follow-up evaluation. This demonstrates that there may be benefit to CD mass screening.
