Case Finding for Celiac Disease With a Point-of-Care Test.

Area of Science:

• Pediatric Gastroenterology
• Public Health
• Preventive Medicine

Background:

• Celiac disease (CD) is frequently underdiagnosed, leading to severe health complications and increased healthcare burdens.
• Early diagnosis and treatment of CD are crucial for mitigating long-term morbidity and mortality.

Purpose of the Study:

• To prospectively evaluate the feasibility and effectiveness of implementing a case-finding strategy for celiac disease in young children.
• To assess the diagnostic yield of point-of-care testing for celiac disease autoantibodies within a preventive youth health care setting.

Main Methods:

• A prospective study involving children aged 1-4 years attending Dutch Preventive Youth Health Care Centers (YHCCs) from February 2019 to January 2022.
• Point-of-care testing for celiac autoantibodies (TGA-IgA/IgG/IgM) was performed in children with at least one CD-associated symptom.
• Diagnostic confirmation involved elevated TGA-IgA levels or specific histopathological findings alongside positive autoantibodies.

Main Results:

• Of 14,917 participating parents, 35.5% reported symptoms. Case finding identified 56 children with confirmed CD (1.7%), with a median age of 2.6 years.
• The incidence rate of CD diagnosed via case finding was 1.67 per 1000 person-years, significantly higher than the standard care rate of 0.14 per 1000 person-years (P < .001).
• Abdominal distention was the only symptom significantly more frequent in children with CD.

Conclusions:

• Case finding for celiac disease using point-of-care tests is both effective and feasible within Dutch Preventive YHCCs.
• Integrating this case-finding strategy into routine care can facilitate timely diagnosis of celiac disease in childhood.