At-Risk Screened Children with Celiac Disease are Comparable in Disease Severity and Dietary Adherence to Those Found because of Clinical Suspicion: A Large Cohort Study.
To assess whether children at risk for celiac disease should be screened systematically by comparing their baseline and follow-up characteristics to patients detected because of clinical suspicion.



Five hundred four children with celiac disease were divided into screen-detected (n = 145) and clinically detected cohorts (n = 359). The groups were compared for clinical, serologic, and histologic characteristics and laboratory values. Follow-up data regarding adherence and response to gluten-free diet were compared. Subgroup analyses were made between asymptomatic and symptomatic screen-detected patients.



Of screen-detected patients, 51.8% had symptoms at diagnosis, although these were milder than in clinically detected children (P < .001). Anemia (7.1% vs 22.9%, P < .001) and poor growth (15.7% vs 36.9%, P < .001) were more common, and hemoglobin (126 g/l vs 124 g/l, P = .008) and albumin (41.0 g/l vs 38.0 g/l, P = .016) were lower in clinically detected patients. There were no differences in serology or histology between the groups. Screen-detected children had better dietary adherence (91.2% vs 83.2%, P = .047). The groups showed equal clinical response (97.5% vs 96.2%, P = .766) to the gluten-free diet. In subgroup analysis among screen-detected children, asymptomatic patients were older than symptomatic (9.0  vs 5.8 years of age, P = .007), but the groups were comparable in other variables.



More than one-half of the screen-detected patients with celiac disease had symptoms unrecognized at diagnosis. The severity of histologic damage, antibody levels, dietary adherence, and response to treatment in screen-detected cases is comparable with those detected on a clinical basis. The results support active screening for celiac disease among at-risk children.
Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
Laura
L
Kivelä
School of Medicine, University of Tampere, Tampere, Finland; Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
Katri
K
Kaukinen
Tampere School of Health Sciences, University of Tampere, Tampere, Finland.
Heini
H
Huhtala
Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
Marja-Leena
ML
Lähdeaho
Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
Markku
M
Mäki
Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland. Electronic address: kalle.kurppa@uta.fi.
Kalle
K
Kurppa
D000293:Adolescent; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D055050:Diet, Gluten-Free / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
celiac antibodies; clinical presentation; follow-up; gluten-free diet; screening; symptoms; villous atrophy