Impact of mass screening for gluten-sensitive enteropathy in working population.
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.
Mariné
Meritxell
M
Department of Gastroenterology, University Hospital of Mútua de Terrassa, Research Foundation Mútua de Terrassa, University of Barcelona, 08221 Terrassa, Catalonia, Spain.
Fernández-Bañares
Fernando
F
Alsina
Montserrat
M
Farré
Carme
C
Cortijo
Montserrat
M
Santaolalla
Rebeca
R
Salas
Antonio
A
Tomàs
Margarita
M
Abugattas
Elias
E
Loras
Carme
C
Ordás
Ingrid
I
Viver
Josep-M
JM
Esteve
Maria
M
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
D005819:Genetic Markers; D006683:HLA-DQ Antigens; D007070:Immunoglobulin A; D011503:Transglutaminases