Celiac disease screening at a pediatric outpatient clinic: a feasibility study

Abstract

Objectives

Celiac disease (CD) is a common yet largely underdiagnosed disease. This study aimed to test the feasibility of incorporating a non-targeted CD screening in a pediatric outpatient setting and evaluate its short-term impact on children with serological evidence of disease.

Methods

Over five months, 500 children (aged 2–17 years) attending a general pediatric outpatient clinic in Gothenburg, Sweden, were enrolled and surveyed for current symptoms, quality of life, and background characteristics; 481 children were screened for tissue-transglutaminase antibodies (tTGA); repeated tTGA-positivity was defined as CD autoimmunity (CDA). Children with CDA were investigated for CD and for one year monitored for changes in symptoms, and quality of life.

Results

Eleven of 481 (2.3%) screened children had CDA. Children with CDA were younger (median 3.8 years) than those without CDA (8.8 years). No other major between-group differences were reported in background characteristics, symptoms, or quality of life. The screening was well-accepted by the families/participants. During 1-year follow-up, 8 of 11 children with CDA were diagnosed with CD. Children with screening-detected CD reported no significant changes in symptoms and quality of life and the dietary adherence rate was good.

Conclusions

Non-targeted screening for CD was feasible in a general pediatric outpatient setting. While hampered by small sample size, our results are in line with previous screening studies indicating that symptoms do not differentiate CDA from non-CDA children. Also, among an overall minimal-symptomatic group of children, diagnosing CD and installation of treatment did not significantly change their well-being during 1-year follow-up.

Keywords:

• Celiac disease
• gluten-free diet
• mass screening
• quality of life

Acknowledgments

The screening approach was developed according to advice from Dr Marian Rewers who has initiated the Autoimmunity Screening for Kids (ASK) program at Barbara Davis Center for Diabetes, CO, USA. The authors are grateful to all families participating in this study and for the support from the personnel at the Hisingen general pediatric outpatient clinic in Gothenburg, Sweden.

Author contributions

Karl Mårild conceptualized and designed the study as well as acquired the data. Statistics were done by Henrik Albrektsson. Sunna Gunnarsdottir wrote the first version of the manuscript. Karl Mårild, Jenny M. Kindblom, Nicolae Miron, Julia Frydebo and Ketil Størdal critically revised the manuscript. Karl Mårild supervised the project and takes responsibility for the integrity of the data. All authors contributed to the interpretation of the data and approved the final manuscript as submitted.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

According to the Ethical approval for this study data cannot be shared. www.clinicaltrial.gov, identification number: NCT03966625.

Additional information

Funding

The study was supported by a grant to investigator Karl Mårild from the Swedish state under the agreement between the Swedish government and the country councils, the ALF-agreement [ALFGBG-771121], the regional board of healthcare in Region Västra Götaland [Dnr 845681] and The Swedish Society of Medicine [Dnr SLS-875781 and SLS-877851]. The funders had no role in the design and conduct of the study or the management and interpretation of the data.