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UK Researchers find Celiac Disease in One Percent of Children and Conclude that it is a Largely Missed Children's Disease

BMJ 2004;328:322-323 (7 February)

Celiac.com 02/18/2004 - A study conducted by researchers in the UK has found that 1% of all seven year old children in the UK have celiac disease, and most cases of celiac disease continue to remain undiagnosed. The researchers tested 5,470 "normal" children using a two stage screening that included an initial radioimmunoassay for antibodies to tissue transglutaminase (endomysial antigen), and a further testing of positive samples for IgA-EMA by indirect immunofluorescence. Children with tTG antibodies under the 97.5th percentile were defined as antibody negative. Out of those tested 54 were positive for IgA-EMA. Additionally: "IgA-EMA positive children were shorter and weighed less than those who tested negative for tTG antibody."

The Researchers Comment:

"At age 7, 1% of children were IgA-EMA positive and likely therefore to have sub clinical coeliac disease, though less than 0.1% were reported to be on a gluten-free diet. The prevalence of coeliac disease in these children is therefore comparable to that in UK adults. The benefit of early diagnosis of sub clinical coeliac disease remains unproven, but long term follow up of this cohort may help to resolve this. If screening is worth while, it should be started in childhood."

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"Since ALSPAC is an observational study based on analysis of anonymous samples, confirmatory biopsy was not possible...(R)eported clinical features were similar to those in adults with coeliac disease identified by screening. Gastrointestinal symptoms were not prominent, and the excess in girls mirrors that seen in affected adults. The most striking observation was that children with IgA-EMA were shorter by more than 0.76 standard deviation scores and lighter by 0.54 standard deviation scores than antibody negative children matched for date and place of birth. This equates to about 9 months growth and weight gain in an average child around this age. These features were independent of gastrointestinal symptoms and anemia and presumably unrelated to malabsorption."

Conclusion:

"Occult coeliac disease seems to start in childhood, even in those who are subsequently diagnosed as adults. The search for the trigger resulting in the breakdown of immune tolerance to gluten therefore needs to focus on infancy and intrauterine life."

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