Screening Guidelines Fail to Detect Celiac Disease in Kids

Results from a new population-based study suggest the current screening guidelines for detecting undiagnosed celiac disease (CD) do not adequately identify the condition in children.

Published online January 13, 2014, in Pediatrics, the study focused on 12-year-old sixth grade students from 5 regions in Sweden. The children and their parents were asked to fill out questionnaires on the frequency of CD-associated symptoms and conditions, including poor appetite, fatigue, nausea, stomachache, upset stomach, abdominal gas, bloating, hard stools, loose stools, and lactose intolerance. The parents also reported on the presence of CD-associated disorders like anemia, type 1 diabetes, thyroid disease, and vitiligo in their children.

From the 7,208 kids tested for tissue transglutaminase immunoglobulin A (IgA) or tissue transglutaminase immunoglobulin B (IgB), 192 (2.7%) were found to have elevated levels of the antibodies. Of those children, 153 (2.1%) tested positive for CD in a small-bowel biopsy confirmation.

But when Anna Rosén, MD, PhD, and colleagues from Umeå University compared the questionnaire answers of children with screening-detected CD to those without it, there was no significant difference in the frequency of CD or CD-associated conditions.

According to the researchers, “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 2,282 children (37%) in the study population.”

“Our findings indicate that a questionnaire concerning symptoms cannot be used to discriminate unrecognized CD children from their non-CD peers,” the authors wrote, noting their conclusion is “in line with a recent CD screening study in adults in the United States.” CD-associated conditions were similarly ineffective as a screening tool.

The investigators said their study raises questions about whether it is ever justifiable to place a child on a gluten-free diet without making a clear diagnosis of CD, and they suggested revisiting the current recommendations for CD screening.