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Mass Screening Proves Helpful in Spotting Celiac Disease

Celiac.com 04/13/2009 - A team of Spanish researchers recently set out to determine rates and clinical status of gluten sensitive enteropathy (GSE) detected by mass blood screens. The researchers also sought to determine sensitivity of anti-transglutaminase (tTGA) and anti-endomysium antibodies (EmA) in diagnosis, and compliance with a gluten-free diet (GFD) and follow-up.

The research team was made up of doctors Meritxell Mariné, Fernando Fernández-Bañares, Montserrat Alsina, Carme Farré, Montserrat Cortijo, Rebeca Santaolalla, Antonio Salas, Margarita Tomàs, Elias Abugattas, Carme Loras, Ingrid Ordás, Josep M Viver, and Maria Esteve.

Researchers recruited one thousand, eight hundred and sixty eight subjects, who were the screened for tTGA and EmA.

Positive screens were referred for duodenal biopsy, DQ2/DQ8 genotyping, clinical feature charting, blood tests, and densitometry.

More than 98% of subjects showed tTGA levels below 2 U/mL,
so researchers designated this as the baseline level for normality, and deemed results positive at or above this level if confirmed twice in a single sample. Researchers also charted adherence to a GFD and follow-up results.

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A total of 26 subjects (1.39%) showed positive tTGA and/or EmA results, Of those, 21 underwent biopsy, with results showing six Marsh Ⅲ (one Ⅲa, four Ⅲb, one Ⅲc), nine Marsh Ⅰ and six Marsh 0, with a GSE rate of 1:125.

EmA sensitivity for GSE was 46.6% (11.1% for Marsh Ⅰ, 100%
for Marsh Ⅲ), while tTGA, sensitivity was 93.3% (88.8% for Marsh Ⅰ, 100% for Marsh Ⅲ).

All 15 patients with abnormal blood tests showed clinical manifestations related to GSE. Marsh Ⅰ and Ⅲ subjects showed more abdominal pain than Marsh 0 (P = 0.029), and also showed more distention and diarrhea. The team saw no differences in the rates of osteopenia between Marsh Ⅰ and Ⅲ (P = 0.608). They found that 66.7% of the 15 GSE patients complied with a gluten-free diet, and that 80% responded positively to the diet. 69.2% participated in follow-up study.

This study showed positive blood screens in nearly 1.4% of those tested. The study showed frequent and clinically relevant rates of GSE among the general population. This confirms that celiac disease and related conditions are at least as common as the 1% figure commonly quoted, and indicate that when criteria are expanded to include less severe cases, they may be even higher.

The study confirmed tTGA as the marker of choice, and showed that mass screening programs such as this one are helpful in spotting celiac disease early, and in referring people for treatment and follow-up before the disease develops into more costly and debilitating conditions often associated with untreated celiac disease.


World J Gastroenterol. 2009 March 21; 15(11): 1331–1338.

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