Advantages to Early Intervention for Asymptomatic Celiac Disease

Celiac.com 06/13/2011 - Serological screening of asymptomatic people at risk for celiac disease is an effective method for spotting the disease and prompting early treatment, according to the results of a study by researchers from Finland, presented at Digestive Disease Week 2011.

The study team showed that diagnosing and treating celiac disease in its earliest stages is beneficial in most screen-detected asymptomatic patients.

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Most of the patients the team studied were willing to continue on a gluten-free diet. On that basis, they assert that it is reasonable to screen at-risk groups.

Lead author Kalle Kurppa, MD, from the University of Tampere in Finland noted that about 2% of the population has celiac disease, but that 90% of affected persons are never formally diagnosed.

"Screening for celiac disease is problematic, and treatment is difficult. It is also unclear whether early diagnosis and treatment of screen-detected celiac disease is truly beneficial," Dr. Kurppa said.

The study team set out to assess the benefit of adopting a gluten-free diet in asymptomatic adults with positive endomysial antibody (EmA) serological screens.

For the study, the team recruited 3031 relatives of patients with celiac disease.  Of these, 148 showed positive EmA scans. 40 of these patients agreed to be randomly assigned to continue their gluten-containing diets (n = 20) , or to start a gluten-free diet (n = 20).

In addition to screening for EmA testing, the study team tested for transglutaminase 2 antibodies, and surveyed patients using the Gastrointestinal Symptoms Rating Scale and Psychological General Well-Being instrument.

The team evaluated laboratory parameters, celiac-specific genetics, bone mineral density, and body composition, along with small bowel mucosal morphology and inflammation.

The team assessed patients at baseline and again after one year, at which time 18 of 20 control patients chose to begin the gluten-free diet as well.

The team observed improvements in all patient parameters. The gluten-free diet group showed mucosal healing (changes in the villous height/crypt depth ratio); the control patients did not (P < .001).

As senior investigator Katri Kaukinen, MD, PhD, explained in a press briefing: "After one year, those on a normal gluten diet had persistence or even a worsening of mucosal lesions, but those who started on a gluten-free diet showed recovery of the mucosa. The difference was really significant at one year."

The group on the gluten-free diet also showed significantly reduced EmA titers (P < .001) and transglutaminase 2 antibody titers (P < .001) from baseline, along with improvements in symptoms (P < .001) and quality of life (P < .001), compared with the control patients.

Control patients who switched to a gluten-free diet showed similar changes in all areas, except for quality of life after 1 year.

Average laboratory readings, body mass index, and bone mineral density all registered within normal ranges at baseline, and showed no significant changes with the intervention. Also, folate and vitamin B12 levels showed substantial improvements on the gluten-free diet.

Overall, patients had positive attitudes toward screening and the dietary intervention, Dr. Kurppa pointed out. Twenty-seven patients (67%) reported adherence to the gluten-free diet, 10 patients (25%) reported minor lapses, and only 3 patients (8%) reported a lack of adherence.

Thirty-four patients (85%) were open to maintaining the gluten-free diet going forward.

Five percent of patients found the gluten-free diet  'easy', Sixty-seven percent found it 'quite easy', while just thirteen percent of patients found if 'difficult.' Somehow, fifteen percent were "uncertain" about that question.

Over half of the patients found the serological screening to be positive or very positive, and none found it to be a negative experience.

Dr. Kaukinen noted at the press briefing that although patients first showed few, if any, symptoms, they reported feeling much better on the gluten-free diet.

"We don't know why celiac patients have these different clinical phenotypes, why some get severe symptoms and others do not," said Kaukinen. It could be that people adapt to minor symptoms, and only realize their symptoms after they are gone. "Some patients told us they felt totally different on the diet," she added.

Dr. Kaukinen says that the goal of early detection is to prevent worsening of symptoms, vitamin deficiencies, and possibly a loss in bone mineral density. "If we see early signs of disease, why should we wait when we can do something for them now?" she asked.

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