Childhood coeliac disease: towards an improved serological mass screening strategy
Version of Record online: 25 DEC 2009
© 2010 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 31, Issue 7, pages 760–766, April 2010
How to Cite
HOGEN ESCH, C. E., CSIZMADIA, G. D. S., VAN HOOGSTRATEN, I. M. W., SCHREURS, M. W. J., MEARIN, M. L. and VON BLOMBERG, B. M. E. (2010), Childhood coeliac disease: towards an improved serological mass screening strategy. Alimentary Pharmacology & Therapeutics, 31: 760–766. doi: 10.1111/j.1365-2036.2009.04226.x
- Issue online: 1 MAR 2010
- Version of Record online: 25 DEC 2009
- Publication data Submitted 29 September 2009 First decision 14 October 2009 Resubmitted 13 December 2009 Accepted 23 December 2009 Epub Accepted Article 25 December 2009
Aliment Pharmacol Ther 31, 760–766
Background In 1997–1998, 6127 asymptomatic children aged 2–4 years were screened for coeliac disease (CD) by anti-endomysium (EmA) testing in the Netherlands. After 6 (±2) months, biopsies were performed in 57 seropositive children; 31(54%) had villous atrophy, but 26 (46%), all HLA-DQ2/DQ8 positive, had normal histology.
Aims To reduce the number of unnecessary biopsies after serological mass screening for CD in asymptomatic young children by optimizing screening procedures.
Methods Comparing different tests and optimizing their cut-off point: screening samples were tested for EmA, tissue-transglutaminase (tTGA), antigliadin and deamidated-gliadin-peptides (anti-DGP) antibodies. Determining serological persistence over time: persistence of EmA and tTGA was determined by testing serological samples obtained at biopsy.
Results Tissue-transglutaminase and anti-DGP correlated with EmA. Optimization of standard cut-off points not only reduced unnecessary biopsies by 50–96% but also reduced sensitivity. EmA persisted in all CD children, but in only 50% of the non-CD children. tTGA persisted in 83% of CD, but in only 15% of non-CD children.
Conclusions Coeliac disease antibodies may be present transiently in genetically predisposed children. To avoid unnecessary biopsies, serological mass screening procedures may be improved by repeating EmA and/or tTGA in initially seropositive young children after 6 months, before proceeding to biopsy. This may reduce the number of unnecessary biopsies that are performed.