title: Impact of mass screening for gluten-sensitive enteropathy in working population.
abstract: OBJECTIVE
  To assess: (1) frequency and clinical relevance of gluten sensitive enteropathy (GSE) detected by serology in a mass screening program; (2) sensitivity of antitransglutaminase (tTGA) and antiendomysium antibodies (EmA); and (3) adherence to gluten-free diet (GFD) and follow-up.
  
  
  METHODS
  One thousand, eight hundred and sixty-eight subjects recruited from an occupational health department underwent analysis for tTGA and EmA and, if positive, duodenal biopsy, DQ2/DQ8 genotyping, clinical feature recording, blood tests, and densitometry were performed. Since > 98% of individuals had tTGA < 2 U/mL, this value was established as the cut-off limit of normality and was considered positive when confirmed twice in the same sample. Adherence to a GFD and follow up were registered.
  
  
  RESULTS
  Twenty-six (1.39%) subjects had positive tTGA and/or EmA, and 21 underwent biopsy: six Marsh III (one IIIa, four IIIb, one IIIc), nine Marsh I and six Marsh 0 (frequency of GSE 1:125). The sensitivity of EmA for GSE was 46.6% (11.1% for Marsh I, 100% for Marsh III), while for tTGA, it was 93.3% (88.8% for Marsh I, 100% for Marsh III). All 15 patients with abnormal histology had clinical features related to GSE. Marsh I and III subjects had more abdominal pain than Marsh 0 (P = 0.029), and a similar trend was observed for distension and diarrhea. No differences in the percentage of osteopenia were found between Marsh I and III (P = 0.608). Adherence to follow-up was 69.2%. Of 15 GSE patients, 66.7% followed a GFD with 80% responding to it.
  
  
  CONCLUSIONS
  GSE in the general population is frequent and clinically relevant, irrespective of histological severity. tTGA is the marker of choice. Mass screening programs are useful in identifying patients who can benefit from GFD and follow-up.
authors.affiliation: Department of Gastroenterology, University Hospital of Mútua de Terrassa, Research Foundation Mútua de Terrassa, University of Barcelona, 08221 Terrassa, Catalonia, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Mariné
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernández-Bañares
authors.forename: Montserrat
authors.initials: M
authors.lastname: Alsina
authors.forename: Carme
authors.initials: C
authors.lastname: Farré
authors.forename: Montserrat
authors.initials: M
authors.lastname: Cortijo
authors.forename: Rebeca
authors.initials: R
authors.lastname: Santaolalla
authors.forename: Antonio
authors.initials: A
authors.lastname: Salas
authors.forename: Margarita
authors.initials: M
authors.lastname: Tomàs
authors.forename: Elias
authors.initials: E
authors.lastname: Abugattas
authors.forename: Carme
authors.initials: C
authors.lastname: Loras
authors.forename: Ingrid
authors.initials: I
authors.lastname: Ordás
authors.forename: Josep-M
authors.initials: JM
authors.lastname: Viver
authors.forename: Maria
authors.initials: M
authors.lastname: Esteve
mesh_terms: D001284:Atrophy; D001706:Biopsy; D002446:Celiac Disease / Q000453:epidemiology* / Q000235:genetics / Q000276:immunology / Q000473:pathology; D004386:Duodenum / Q000276:immunology / Q000473:pathology; D005500:Follow-Up Studies; D005819:Genetic Markers; D006683:HLA-DQ Antigens / Q000235:genetics / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007413:Intestinal Mucosa / Q000473:pathology / Q000503:physiopathology; D008403:Mass Screening / Q000379:methods*; D009786:Occupational Health Services / Q000706:statistics & numerical data; D016133:Polymerase Chain Reaction; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D011503:Transglutaminases / Q000276:immunology
chemical_list: D005819:Genetic Markers; D006683:HLA-DQ Antigens; D007070:Immunoglobulin A; D011503:Transglutaminases