Mass Screening for Celiac Disease: The Autoimmunity Screening for Kids Study

Abstract

INTRODUCTION: The Autoimmunity Screening for Kids (ASK) study is a large scale pediatric screening study in Colorado for celiac disease (CD) and type 1 diabetes. This is a report of the CD outcomes for the first 9,973 children screened through ASK. METHODS: ASK screens children aged 1–17 years for CD using 2 highly sensitive assays for tissue transglutaminase autoantibodies (TGA): a radiobinding (RBA) assay for IgA TGA and an electrochemiluminescence (ECL) assay that detects all TGA isotypes. Children who test positive on either assay are asked to return for confirmatory testing. Those with a confirmed RBA TGA level ≥ 0.1 (twice the upper limit of normal) are referred to the Colorado Center for Celiac Disease for further evaluation; all others are referred to primary care. RESULTS: Of the initial 9,973 children screened, 242 children were TGA+ by any assay. Of those initially positive, 185 children (76.4%) have completed a confirmation blood draw with 149 children (80.5%) confirming positive by RBA TGA. Confirmed RBA TGA+ was associated with a family history of CD (odds ratio [OR] = 1.83; 95% confidence interval 1.06–3.16), non-Hispanic white ethnicity (OR = 3.34; 2.32–4.79), and female sex (OR = 1.43; 1.03–1.98). Gastrointestinal symptoms of CD, assessed at the initial screening, were reported equally often among the RBA TGA+ vs TGA− children (32.1% vs 30.5%, P = 0.65). DISCUSSION: The initial results of this ongoing mass-screening program confirm a high prevalence of undiagnosed CD autoimmunity in a screened US population. Symptoms at initial screening were not associated with TGA status (see Visual abstract, Supplementary Digital Content 5, http://links.lww.com/AJG/B587).

Anxiety and Depression in Pediatric Patients with Celiac Disease: A Large Cross-Sectional Study

“…Strengths of this study include using the largest known sample of pediatric patients with CD across a wide age range and applying a validated instrument to evaluate their levels of anxiety and depression symptoms. Further, the study population includes participants derived from the Autoimmunity Screening for Kids (20) , a large-scale pediatric screening effort in Colorado since 2016. Thus, our study population may have included a broader range of CD clinical presentation than previous studies.…”

Reliability of the Multiplex CytoBead CeliAK Immunoassay to Assess Anti-tTG IgA for Celiac Disease Screening

“…Importantly, in addition to the CD screening in patients affected with specific extra-gastrointestinal diseases or manifestations ( 3 , 29 , 30 ), the availability of a cost-effective, but reliable, serological test may be considered for large scale or mass screening, the debate of which is still open ( 5 , 31 , 32 ).…”

“…Importantly, CD in children can be even asymptomatic and, in these cases, can be investigated only later during adolescence or adulthood, because of some long-term complications, such as growth impairment, pubertal disorders, bone density reduction, fertility issues, occurrence of intestinal malignancy, and/or other autoimmune disorders ( 2 , 3 ). Considering the significant prevalence of CD in children (around or at least 1% of the general population) and its raising incidence ( 4 ), CD should be actively sought, especially in those countries where the dietary regimens have been changing (with an even greater presence of wheat foods) and/or this diagnosis has not been appropriately considered until recent years ( 5 – 7 ).…”

Review article: Becoming and being coeliac—special considerations for childhood, adolescence and beyond

“…In the Autoimmunity Screening for Kids (ASK) study, 9973 children aged 1–17 years were screened for CDA regardless of symptoms or their risk for CD 108 . Interim analysis confirmed CDA based on two highly sensitive assays for TTG in 108 children, of which only 40 went on to endoscopy.…”