title: Symptoms and biomarkers associated with celiac disease: evaluation of a population-based screening program in adults.
abstract: OBJECTIVE
  To identify possible early predictors (symptoms and biomarkers) of celiac disease, compare symptoms before and after screening, and evaluate the diagnostic efficacy of serologic screening for celiac disease in an adult Danish population.
  
  
  METHODS
  This cross-sectional population-based study was based on the 5-year follow-up of the Health2006 cohort, where 2297 individuals were screened for celiac disease; 56 were antibody positive and thus invited to clinical evaluation. Eight were diagnosed with biopsy-verified celiac disease. A follow-up questionnaire was sent to antibody-positive individuals 19 months after the clinical evaluation to obtain information on their symptoms and their experience with participation in the screening.
  
  
  RESULTS
  Before screening, participants subsequently diagnosed with celiac disease did not differ from the rest of the population with respect to symptoms, but had significantly lower total cholesterol. Tissue transglutaminase IgA antibodies with a cut-off of 10 U/ml had a positive predictive value of 88%. The majority of participants were satisfied with their participation in the screening program. Individuals with celiac disease were generally satisfied with having been diagnosed and 71% felt better on a gluten-free diet.
  
  
  CONCLUSIONS
  There were no differences in the prevalence of symptoms between participants with and without screening-detected celiac disease, confirming that risk stratification in a general population by symptoms is difficult. The majority of participants diagnosed with celiac disease felt better on a gluten-free diet despite not reporting abdominal symptoms before diagnosis and participants in the clinical evaluation were generally satisfied with participation in the screening program.
authors.affiliation: aResearch Centre for Prevention and Health, The Capital Region, Glostrup bQ&D, Research Unit and Department of Gastroenterology, Herlev and Gentofte Hospital cDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen dDepartment of Clinical Experimental Research, Rigshospitalet, Denmark.
authors.forename: Line L
authors.initials: LL
authors.lastname: Kårhus
authors.forename: Betina H
authors.initials: BH
authors.lastname: Thuesen
authors.forename: Jüri J
authors.initials: JJ
authors.lastname: Rumessen
authors.forename: Allan
authors.initials: A
authors.lastname: Linneberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D055050:Diet, Gluten-Free; D005260:Female; D005500:Follow-Up Studies; D019204:GTP-Binding Proteins / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000523:psychology; D008875:Middle Aged; D017060:Patient Satisfaction; D015397:Program Evaluation; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011795:Surveys and Questionnaires; D011503:Transglutaminases / Q000276:immunology; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins