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    Simple Blood Tests Have Major Impact in Diagnosis of Celiac Disease in Children


    Jefferson Adams

    Celiac.com 01/04/2010 - The practice of using antibody testing to diagnose celiac disease has led to an explosion in the number of cases detected among children, coupled with a rise in median age at diagnosis, a new study suggests.


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    European studies have shown that celiac disease is a multi-system disorder, affecting 0.3% to 1.0% of all children. A team of researchers recently set out to examine the impact of serological testing on childhood celiac disease in North America The research team consisted of Kelly E. McGowan, BHSc, Derek A. Castiglione and J. Decker Butzner, MD with the Department of Pediatrics, University of Calgary, Calgary, Canada.

    Serological testing makes it easier to spot children with atypical or extra-intestinal symptoms or with conditions associated with celiac disease. Serological testing has resulted in a huge increase in celiac disease cases; it has tripled incidence levels, quadrupled diagnosis age, and brought about a greater understanding of the wide variety of presentations of celiac disease in North America.

    Younger children are more likely to develop classic celiac disease, whereas older children seem more likely to show atypical presentations.

    The goal of the study was to determine the effects of immunoglobulin A endomysial antibody testing on the incidence and clinical presentation of childhood celiac disease.

    Researchers compared the incidence and clinical presentation of celiac disease in two groups of patients. Both groups were under a pretesting group of patients under 18 years of age in 1990–1996  and compared with a testing group of  patients under 18 years of age in 2000–2006.

    Average age at diagnosis was 2 years (95% confidence interval: 2–4 years) in the pretest group (N = 36), compared with 9 years (95% confidence interval: 8–10 years) in the test group (N = 199; P < .001); female/male ratios (1.6:1) were similar (P = .982).

    Incidence of celiac disease increased from 2.0 cases per 100,000 children in the pretest group to 7.3 cases per 100,000 children in the test group (P = .0256).

    Frequency of classic celiac disease decreased from 67% in the pretest group to 19% (test group; P < .001), but the incidence of classic celiac disease did not change (0.8 vs 1.6 cases per 100000; P = .154).

    In the test group, researchers uncovered 13 previously unnoticed clinical presentations in 98 children, including 35 with family history, 18 with abdominal pain, and 14 with type 1 diabetes mellitus.

    The frequency of Marsh IIIc lesions decreased from 64% in the pretest group to 44% in the test group (P = .0403).

    In the test group, classic celiac disease was most common, making up 67% of cases in young children under 3 years, whereas atypical gastrointestinal and silent presentations were more common in older children.

    Overall, the contribution of serological testing to the diagnosis of celiac disease has been enormous. Antibody testing for celiac disease has tripled the incidence of celiac disease and quadrupled the average age at diagnosis, thus offering millions of children a higher quality of health.

    Source: Pediatrics, December 2009.

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  • About Me

    Jefferson Adams is a freelance writer living in San Francisco. He has covered Health News for Examiner.com, and provided health and medical content for Sharecare.com. His work has appeared in Antioch Review, Blue Mesa Review, CALIBAN, Hayden's Ferry Review, Huffington Post, the Mississippi Review, and Slate, among others.

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  • Related Articles

    Jefferson Adams
    Celiac.com 07/21/2009 - Accurate blood tests have revolutionized celiac disease diagnosis. Recently, researchers K.E. Evans, A.R. Malloy, and D.A. Gorard set out to review requests for celiac blood testing at a district general hospital laboratory over a decade, to measure the volume of requests, identify their source of referral, and assess positivity rates, along with subsequent rates of duodenal biopsy and histological confirmation.
    The team used laboratory databases to gather details of patients who requested celiac blood tests from 1997 to 2006. They then categorized the referrals inasto gastroenterology, general practice, and pediatrics and other specialities, while excluding duplicate requests.
    The team gathered 9976 serological tests in all. From 1997 to 2006, testing requests increased from 302 to 1826. About two-thirds (66%) of requests were made for women. Tests done on children accounted for 14-25% of each year's total. During that same period, test requests made via general practitioner rose from 3.3% to 52%, while the percentage of positive test results fell from 5.7% to 2.6%.
    The number of duodenal biopsies fell from 85% of seropositive patients in earlier part of the decade to about 75% of seropositive patients in latter part. Most non-biopsied seropositive patients had blood requested by general practitioners. In more than 9 out of 10 seropositive patients (91%), biopsy confirmed celiac disease.
    The data show that, increasingly, most celiac blood tests are now requested by general practitioners, with twice as many women as men being tested.
    Rising requests for blood tests but shrinking rates of positivity suggest that people are getting tested earlier, with fewer or less severe symptoms than in the past. Positive blood tests are often not confirmed histologically.
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    Jefferson Adams
    Celiac.com 06/29/2010 - Properly diagnosing children with celiac disease in conditions where there may be environmental or other causes for classic celiac-associated symptoms, such as malnutrition, diarrhea, and failure to thrive, can present challenges to clinicians.
    A clinical team conducted an assessment of celiac disease blood screens in symptomatic 12 to 36 month-old children. The research team included Inês Cristina Modelli; Lenora Gandolfi; Rodrigo Coutinho de Almeida; Gloria Maria A. C. Araújo; Marilúcia de Almeida Picanço; and Riccardo Pratesi.
    They are associated with the Graduate Program in Health Sciences at the University of Brasilia School of Health Sciences, the Pediatric Department at the Brasilia University Hospital, and the Pediatric Research Center and Celiac Disease Investigation Center at the University of Brasilia School of Medicine in Brazil.
    The clinicians wanted to assess rates of celiac disease in a group of 12 to 36 month-old children using immunoglobulin antibodies against gliadin (IgG and IgA-AGA), against endomysium (IgA-EMA), and anti-human tissue transglutaminase (IgA-tTG) screens.
    For the study, the team enrolled 114 boys and 100 girls, aged 12 to 36 months, all following a gluten-containing diet. The team performed IgG and IgA-AGA, IgA-tTG and IgA-EMA blood tests for each patient. The team took biopsies from all children who showed one or more positive blood test, except those for whom IgG-AGA was the only positive result.
    In cases where IgG-AGA was the only positive result, the team used polymerase chain reaction (PCR) HLA genotyping to identify the celiac disease predisposing alleles. HLA genotyping also allowed the team to confirm diagnosis in children flagged as celiac by means of positive serologic testing and compatible biopsy results.
    The team found that 131 kids showed normal results. PCR showed the presence of celiac disease predisposing alleles in ten out of 68 children who tested positive on just the IgG-AGA test. Four kids had positive results on all four blood tests, while a fifth child showed positive results IgG and IgA-AGA and IgA-tTG, but showed negative results for IgA-EMA. All five children submitted to jejunal biopsies, which showed classic celiac lesions.
    Symptomatic children from 12- to 36-months old that had not been previously diagnosed with celiac disease showed celiac prevalence of 2.3%.
    This study shows several things. First, the data reflect the challenges of diagnosing celiac disease in areas where environmental or other causes for classic celiac-associated symptoms might interfere with proper diagnosis. The results also show the advantages of considering biopsies in cases of conflicting or incomplete blood screens in symptomatic children who may be subject to environmental and other mitigating factors.
    That such symptomatic children show celiac disease rates that are more than double the general population shows that clinicians attempting diagnosis under such circumstances should be both diligent and exhaustive in their efforts. As it is, symptomatic children with celiac disease are going undiagnosed. To properly diagnose such cases, clinicians should consider any environmental or other causes for classic celiac-associated symptoms that might interfere with proper diagnosis.
    There is no reason to assume that these results are exclusive to Brazil. There's no reason to assume these results wouldn't apply anyplace where environmental and other causes might interfere with diagnosis of celiac disease in symptomatic children, including regions of rural and urban poverty.
    Source:

    PEDIATRIC GASTROENTEROLOGY GASTROENTEROLOGIA PEDIÁTRICA vol.47 no.1 São Paulo

    Jefferson Adams
    Celiac.com 01/11/2012 - In an effort to understand how delayed celiac disease diagnosis became the norm for most patients over the last few decades, a research team conducted a study to assess the issue. Their study also looked at how delayed diagnosis affects health-related quality of life (HRQoL) for those with celiac disease, and considered differences with respect to sex and age.
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    The team then compared the results against the results from a survey of the general population. There was some good news and some bad news.
    The good news is that, while the average QALY score during the year before treatment was 0.66, it improved after diagnosis and treatment to 0.86, which is  better than that the score of 0.79 for the general population.
    The bad news is that they found the average person with celiac disease faced a delay in diagnosis of 9.7 years from the first symptoms, and 5.8 years from the first doctor visit.
    The team concede that the delay has been reduced over time for some age groups, but contend that it still remains unacceptably long for large numbers of people.
    Untreated celiac disease results in poor HRQoL, which improves or exceeds that of  the general population if diagnosed and treated. Reducing the delay in diagnosing celiac disease will go a long way toward reducing the burden of celiac disease.
    To do so, they say it is necessary to raise awareness of celiac disease as a common health problem, and to intensify diagnosis practices. This may, the note, make mass-screening for celiac disease an desirable option in the future.
    Authors: Fredrik Norstrom, Lars Lindholm, Olof Sandstrom, Katrina Nordyke, Anneli Ivarsson
    Source:

    BMC Gastroenterology 2011, 11:118. doi:10.1186/1471-230X-11-118

    Jefferson Adams
    Celiac.com 06/27/2013 - Patients with villous atrophy and negative celiac disease serologies pose a diagnostic and therapeutic dilemma.
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    To get a better picture of this dilemma, a team of researchers recently examined the connections between villous atrophy and negative celiac serology.
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    Source:
    Am J Gastroenterol. 2013 May;108(5):647-53. doi: 10.1038/ajg.2013.45.

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    Source:
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    Jefferson Adams
    Celiac.com 06/19/2018 - Could baking soda help reduce the inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease? Scientists at the Medical College of Georgia at Augusta University say that a daily dose of baking soda may in fact help reduce inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease.
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    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
    The research team included P Singh, A Arora, TA Strand, DA Leffler, C Catassi, PH Green, CP Kelly, V Ahuja, and GK Makharia. They are variously affiliated with the Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Lady Hardinge Medical College, New Delhi, India; Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA; Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
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    Rates of celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was 0.6% in female vs 0.4% males. Celiac disease was significantly more common in children than adults.
    This systematic review and meta-analysis showed celiac disease to be reported worldwide. Blood test data shows celiac disease rate of 1.4%, while biopsy data shows 0.7%. The prevalence of celiac disease varies with sex, age, and location. 
    This review demonstrates a need for more comprehensive population-based studies of celiac disease in numerous countries.  The 1.4% rate indicates that there are 91.2 million people worldwide with celiac disease, and 3.9 million are in the U.S.A.
    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.