Jump to content
This site uses cookies. Continued use is acceptance of our Terms of Use and Privacy Policy. More Info... ×
  • Welcome to Celiac.com!

    You have found your celiac tribe! Join us and ask questions in our forum, share your story, and connect with others.




  • Celiac.com Sponsor (A1):



    Celiac.com Sponsor (A1-M):


  • Get Celiac.com Updates:
    Where Your Contribution Counts!
    eNewsletter
    Support Us!
  • Record is Archived

    This article is now archived and is closed to further replies.

    Destiny Stone
    Destiny Stone

    Improving Serological Mass Screening in Childhood Celiac Disease

    Reviewed and edited by a celiac disease expert.

    Celiac.com 03/26/2010 - Mass screening studies among the general population for celiac disease show a prevalence of approximately 0.5-1.0% in adults and in children. Yet, despite the growing numbers of newly diagnosed celiac disease patients, most cases still remain undiagnosed and therefore, untreated. In part, the masses of misdiagnosed or undiagnosed  celiac disease  patients are a result of the variety of disguises  celiac disease can have. Celiac disease can manifest into a multitude of symptoms including, but by no means exclusive to, malabsorption syndrome, diarrhea, anemia, infertility and osteoporosis.

    It has been demonstrated that there is a clear advantage to early testing for celiac disease. Early testing can aide in  avoiding the irreversible damages that come from diagnosis later in life, such as stunted growth and organ damage. It is also faster for children to heal from intestinal lesions caused from undiagnosed celiac disease, when diagnosed early on. New evidence shows that 10 years after being diagnosed with celiac disease, 66% of the children diagnosed exhibited improvement in their health and overall quality of life; indicating that mass screening at an early age is critical.

    Celiac.com Sponsor (A12):
    This study was based on a previous study performed by  mass screening for celiac disease by a group of scientists in the Netherlands between 1997 and 1998, who studied 6,127 asymptomatic children between the ages of two and four. Using endomysial antibodies (IgA EmA) testing, the children were screened for celiac disease. 57 seropositive children were then given biopsies. The scientists compared different testing methods for celiac disease, evaluated their serological persistence over time, and determined optimum cut-off points for the testing. Using serological samples obtained at biopsy, EmA and tTGA was assessed for each subject studied. Human leukocyte antigen  (HLA)-typing was obtained from 55 children; 26 of those had normal biopsies and were genetically predisposed for celiac disease and 29 of the children had small-bowel alterations known to be  distinctive traits for celiac disease. Of the 26 children with normal biopsies, 4% of them tested positively for HLA-DQ8, and the other 96% tested positive for HLS-DQ2. Of the 29 children diagnosed with celiac disease, all of them tested positive for HLA-DQ2. However, a proportionately  large number of children who tested EmA-positive and were diagnosed with celiac disease, had normal biopsies and were thus regarded as  false positives.

    The results of this test confirmed that celiac disease antibody levels may fluctuate in children who are genetically predisposed for  celiac disease. While the reason for the transient antibodies is still not known, it has been suggested that children who are seropositive but have normal small-intestine biopsies, potentially have celiac disease, and are susceptible to developing gluten sensitive enteropathy as they get older. Future testing is needed to establish results for this hypothesis.

    However, children with histological alterations in their small-intestine biopsy indicative of celiac disease, had considerably higher antibodies for EmA than those without celiac disease.  The tTGA levels were significantly higher and occurred with more frequency in children with celiac disease than in children without celiac disease. EmA persisted in all celiac disease children, but only in 50% of the non-celiac disease children. tTGA was evident in 83% of celiac disease children, and 15% in non-celiac disease children. Additionally, increasing the cut-off points  provided a reduction of false positives, but resulted in lowering test sensitivity. While optimization of standard cut-off points reduced unnecessary biopsies by 50%-96%, it also reduced test sensitivity.

     In conclusion, celiac disease antibodies are proven to be transient in children genetically predisposed to celiac. It is therefore crucial for medical providers to reduce the number of unnecessary biopsies. As this study has demonstrated,  to reduce the number of unnecessary biopsies by 85%, serological mass screening methods may be improved by repeating EmA and/or tTGA in children who test seropositive after 6 months, and before continuing to biopsy.

    Source:

    • Open Original Shared Link



    User Feedback

    Recommended Comments

    There are no comments to display.



    Guest
    This is now closed for further comments

  • Get Celiac.com Updates:
    Help Celiac.com:
    Donate
  • About Me

    Destiny Stone

    I diagnosed myself for gluten intolerance after a lifetime of bizarre, seemingly unrelated afflictions. If my doctors had their way, I would have already undergone neck surgery, still be on 3 different inhalers for asthma, be vomiting daily and having chronic panic attacks. However, since eliminating gluten from my diet in May 2009, I no longer suffer from any of those things. Even with the proof in the pudding (or gluten) my doctors now want me to ingest gluten to test for celiac-no can do.


  • Celiac.com Sponsor (A17):
    Celiac.com Sponsor (A17):





    Celiac.com Sponsors (A17-M):




  • Related Articles

    Scott Adams
    Great Smokies Diagnostic Laboratory (GSDL), a private, rapid-growth Functional Medicine Clinical laboratory, announced today receipt of 510(K) market clearance from the Food and Drug Administration (FDA) for its Intestinal Permeability test kit, utilizing the lactulose-mannitol challenge drink. Used in the non-invasive assessment of intestinal permeability, the test demonstrated its superior sensitivity as compared to the existing d-xylose test in measuring intestinal permeability, a measurement used in the diagnosis of gastrointestinal malabsorption syndromes, such as celiac disease, colitis, Crohns disease, and Irritable Bowel Syndrome.
    What is intestinal permeability?
    Intestinal permeability refers to impairment of the intestinal mucosal barrier, which is central ...


    Scott Adams
    J Pediatr 2000;137:356-366.
    Celiac.com 10/10/2000 - Researchers from the University of Colorado School of Medicine, Denver have determined that transglutaminase (TG) antibodies in asymptomatic children are 70% to 83% predictive of biopsy evidence of celiac disease, and may identify children who are likely to develop the disease, as reported in the September issue of the Journal of Pediatrics.
    Dr. Edward J. Hoffenberg and colleagues studied 30 asymptomatic children who had a genetic risk for celiac disease to determine the relationships between TG antibody titer, small bowel histology, growth, and clinical features of celiac disease. Using the Marsh System to grade the small bowel histology Dr. Hoffenberg that out of 30 children with a positive TG antibody test result...


    Tina Turbin
    Celiac.com 05/28/2010 - Celiac disease research is linking Irritable Bowel Syndrome with gluten intolerance and doctors are recommending IBS sufferers, especially those with diarrhea-predominant IBS, to get tested for gluten issues or celiac disease. Celiac disease is an autoimmune disease. The source of this being gluten, a protein found in wheat, barley, and rye, often affecting the entire body and manifesting various physical and mental symptoms, and a gluten-free diet is the simple treatment for this disease.
    New research published in the Archives of Internal Medicine has shown that people with IBS are four times more likely to have celiac disease than those without IBS. Doctors, often uneducated about celiac disease or improperly taught that its symptoms are dramatic, don’t associate t...


    Dr. Tom O'Bryan
    Question:  Do I have to re-introduce gluten in order to have an accurate gluten sensitivity test done?
     Answer: Yes and No
     If a person knows they are sensitive to gluten and have gone on a gluten-free diet, and want to know if they can have gluten again, then a  challenge is in order (reintroduce gluten). THIS IS STRONGLY NOT RECOMMENDED. The gluten challenge has many cases of people who were damaged (some permanently) from the reaction to reintroducing gluten Even Small Amounts of Gluten Cause Relapse in Children With Celiac Disease, Journal of Pediatric Gastroenterology and Nutrition 34:26­30,   and it is no longer a requirement for diagnosing celiac disease Am J Clin Nut 1999;69:354-65.
     Among 374 children in whom celiac disease was diagnosed before the age of 2, 5% dev...


  • Recent Activity

    1. - Tlbaked13 replied to djmu's topic in Related Issues & Disorders
      8

      Peripheral Neuropathy

    2. - trents replied to JustGemi's topic in Celiac Disease Pre-Diagnosis, Testing & Symptoms
      8

      SCARED: What Do These Test Results Mean?

    3. - Scott Adams replied to Kaylee G's topic in Gluten-Free Recipes & Cooking Tips
      1

      Learning to cook for myself

    4. - JustGemi replied to JustGemi's topic in Celiac Disease Pre-Diagnosis, Testing & Symptoms
      8

      SCARED: What Do These Test Results Mean?


  • Celiac.com Sponsor (A19):



  • Member Statistics

    • Total Members
      120,478
    • Most Online (within 30 mins)
      7,748

    Susan Maxwell- Trumble
    Newest Member
    Susan Maxwell- Trumble
    Joined

  • Celiac.com Sponsor (A20):


  • Forum Statistics

    • Total Topics
      120.2k
    • Total Posts
      1m

  • Celiac.com Sponsor (A22):





  • Celiac.com Sponsor (A21):



  • Popular Now

    • JustGemi
    • Linedancegal
    • Hannah24
      9
    • jessiemariecar
    • Rhonda H
  • Popular Articles

    • Scott Adams
    • Scott Adams
    • Scott Adams
    • Scott Adams
    • Scott Adams
  • Upcoming Events

×
×
  • Create New...