title: Usefulness of symptoms to screen for celiac disease.
abstract: OBJECTIVE
  To describe the frequency of symptoms and associated conditions among screening-detected celiac disease (CD) cases and non-CD children and to evaluate questionnaire-based case-finding targeting the general population.
  
  
  METHODS
  In a population-based CD screening of 12-year-olds, children and their parents completed questionnaires on CD-associated symptoms and conditions before knowledge of CD status. Questionnaire data for those who had their CD detected in the screening (n = 153) were compared with those of children with normal levels of CD markers (n = 7016). Hypothetical case-finding strategies were also evaluated. Questionnaires were returned by 7054 (98%) of the children and by 6294 (88%) of their parents.
  
  
  RESULTS
  Symptoms were as common among screening-detected CD cases as among non-CD children. The frequency of children with screening-detected CD was similar when comparing the groups with and without any CD-related symptoms (2.1% vs 2.1%; P = .930) or CD-associated conditions (3.6% vs 2.1%; P = .07). Case-finding by asking for CD-associated symptoms and/or conditions would have identified 52 cases (38% of all cases) at a cost of analyzing blood samples for 2282 children (37%) in the study population.
  
  
  CONCLUSIONS
  The current recommended guidelines for finding undiagnosed CD cases, so-called active case-finding, fail to identify the majority of previously undiagnosed cases if applied in the general population of Swedish 12-year-olds. Our results warrant further studies on the effectiveness of CD case-finding in the pediatric population, both at the clinical and population-based levels.
authors.affiliation: Departments of Public Health and Clinical Medicine, Epidemiology and Global Health.
authors.forename: Anna
authors.initials: A
authors.lastname: Rosén
authors.forename: Olof
authors.initials: O
authors.lastname: Sandström
authors.forename: Annelie
authors.initials: A
authors.lastname: Carlsson
authors.forename: Lotta
authors.initials: L
authors.lastname: Högberg
authors.forename: Ola
authors.initials: O
authors.lastname: Olén
authors.forename: Hans
authors.initials: H
authors.lastname: Stenlund
authors.forename: Anneli
authors.initials: A
authors.lastname: Ivarsson
mesh_terms: D002446:Celiac Disease / Q000175:diagnosis*; D002648:Child; D003663:Decision Trees; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013548:Sweden
keywords: case-finding; celiac disease; questionnaire; screening; symptom