Coeliac disease in the year 2000: exploring the iceberg

Area of Science:

• Gastroenterology
• Immunology
• Pediatrics

Background:

• Subclinical coeliac disease is increasingly recognized as common in the general population.
• Early detection and management of coeliac disease are crucial for preventing long-term complications.

Purpose of the Study:

• To assess the feasibility and effectiveness of a multi-level screening program for subclinical coeliac disease in a school-aged population in central Italy.
• To determine the prevalence of subclinical coeliac disease within this demographic.

Main Methods:

• A three-level screening approach was employed: first-level IgG and IgA antigliadin antibody (AGA) assay on capillary blood, second-level AGA, IgA anti-endomysium antibody (AEA) testing, and serum immunoglobulin measurement in venous blood, followed by intestinal biopsy for confirmed cases.
• 3351 students aged 11-15 years participated in the first-level screening.

Main Results:

• 71 students (2%) were recalled for AGA positivity, with 18 proceeding to intestinal biopsy.
• Coeliac disease was diagnosed in 11 subjects (3.28 per 1000), most of whom were asymptomatic.
• Selective IgA deficiency was identified in 4 subjects, with one also having coeliac disease.

Conclusions:

• Population-based screening for subclinical coeliac disease is feasible and well-tolerated in schoolchildren.
• Screening effectively identifies asymptomatic coeliac disease cases that might otherwise go undetected.
• Early diagnosis through screening allows for timely intervention with a gluten-free diet, improving patient outcomes.