title: Childhood coeliac disease: towards an improved serological mass screening strategy.
abstract: BACKGROUND
  In 1997-1998, 6127 asymptomatic children aged 2-4 years were screened for coeliac disease (CD) by anti-endomysium (EmA) testing in the Netherlands. After 6 (+/-2) months, biopsies were performed in 57 seropositive children; 31(54%) had villous atrophy, but 26 (46%), all HLA-DQ2/DQ8 positive, had normal histology.
  
  
  OBJECTIVE
  To reduce the number of unnecessary biopsies after serological mass screening for CD in asymptomatic young children by optimizing screening procedures.
  
  
  METHODS
  Comparing different tests and optimizing their cut-off point: screening samples were tested for EmA, tissue-transglutaminase (tTGA), antigliadin and deamidated-gliadin-peptides (anti-DGP) antibodies. Determining serological persistence over time: persistence of EmA and tTGA was determined by testing serological samples obtained at biopsy.
  
  
  RESULTS
  Tissue-transglutaminase and anti-DGP correlated with EmA. Optimization of standard cut-off points not only reduced unnecessary biopsies by 50-96% but also reduced sensitivity. EmA persisted in all CD children, but in only 50% of the non-CD children. tTGA persisted in 83% of CD, but in only 15% of non-CD children.
  
  
  CONCLUSIONS
  Coeliac disease antibodies may be present transiently in genetically predisposed children. To avoid unnecessary biopsies, serological mass screening procedures may be improved by repeating EmA and/or tTGA in initially seropositive young children after 6 months, before proceeding to biopsy. This may reduce the number of unnecessary biopsies that are performed.
authors.affiliation: Department of Paediatric Gastroenterology, Leiden University Medical Center, Leiden, The Netherlands. c.e.hogen_esch@lumc.nl
authors.forename: C E
authors.initials: CE
authors.lastname: Hogen Esch
authors.forename: G D S
authors.initials: GD
authors.lastname: Csizmadia
authors.forename: I M W
authors.initials: IM
authors.lastname: van Hoogstraten
authors.forename: M W J
authors.initials: MW
authors.lastname: Schreurs
authors.forename: M L
authors.initials: ML
authors.lastname: Mearin
authors.forename: B M E
authors.initials: BM
authors.lastname: von Blomberg
mesh_terms: D000906:Antibodies / Q000097:blood / Q000276:immunology; D001706:Biopsy; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D002675:Child, Preschool; D003641:Deamination / Q000276:immunology; D005903:Gliadin / Q000097:blood / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood / Q000276:immunology; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D008403:Mass Screening / Q000379:methods*; D011503:Transglutaminases / Q000097:blood / Q000276:immunology
chemical_list: D000906:Antibodies; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005903:Gliadin; D011503:Transglutaminases