Diagnosis, treatment of celiac disease via screening program improves outcomes in children
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Key takeaways:
- Mean symptom severity and frequency scores improved at 1 year in children identified with celiac disease through a mass screening program.
- Improvements also were reported in quality of life and iron deficiency.
Children diagnosed with celiac disease and treated through a statewide screening program experienced improvements in initially unrecognized symptoms and quality of life, as well as greater adherence to a gluten-free diet, research showed.
“Despite increasing prevalence and often delayed diagnosis, mass screening for CD remains controversial,” Marisa G. Stahl, MD, MSCS, assistant professor of pediatrics at University of Colorado Anschutz Medical Campus, and colleagues wrote in Clinical Gastroenterology and Hepatology. “The Autoimmunity Screening for Kids (ASK) Study — a pediatric general population screening study for celiac disease and type 1 diabetes in Colorado — is designed to assess the benefits and cost-effectiveness of the screening.”
They added, “ASK has previously reported that 2.4% of Colorado children had previously undiagnosed celiac disease autoimmunity.”
Stahl and colleagues prospectively evaluated health-related outcomes among children aged 1 to 17 years who screened positive for tissue transglutaminase IgA (tTGA) autoantibodies in the ASK study and were later diagnosed with celiac disease via biopsy or serologic criteria.
Researchers assessed demographics, lab values, symptoms, health-related quality of life, mental health and adherence to a gluten-free diet at baseline and 12 months.
Of 52 enrolled children, 42 completed the 12-month follow-up and 38 reported at least one symptom of celiac disease at the diagnostic evaluation. Ten children were lost to follow-up.
According to study results, mean symptom severity and frequency scores significantly improved from baseline to follow-up, as did health-related quality of life among caregivers. At baseline, iron deficiency without anemia was reported in 87.5% of children, which normalized in 52.3% of them at follow-up. Symptoms of anxiety and depression reported by caregivers and children were mostly unchanged from baseline to follow-up.
In addition, 26 out of 28 families reported good or excellent adherence to a gluten-free diet, with all of those children demonstrating “down-trending” tTGA autoantibodies at 12 months.
“Overall, the follow-up of children identified to have celiac disease through the Colorado ASK screening program suggests that mass screening and treatment improves previously unrecognized symptoms, health-related quality of life and iron deficiency while not increasing symptoms of anxiety or depression,” Stahl and colleagues wrote. “Additional studies are needed to determine the most cost-effective approach to mass screening and how mass screening compares to current targeted screening practices with respect to outcomes before policy changes can be considered in support of celiac disease mass screening.”
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