Ninety Percent of Celiac Disease Is Being Missed

Ravikumara, Madhur; Nootigattu, V. K. T.; Sandhu, Bhupinder

doi:10.1097/mpg.0b013e31812e5710

Cited by 69 publications

(53 citation statements)

References 19 publications

(23 reference statements)

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“…If this is confirmed in other studies, individuals with untreated silent CD may be exposed to the same risk for long-term complications as celiacs with symptomatic disease (1,17,18). This is an argument in favour of a mass-screening for CD in children (19)(20)(21), although many aspects of widespread screening must be considered (15,22). There were 15 children with untreated, screening-detected CD, 36 children with untreated, symptomatic CD and 42 healthy control children.…”

Section: Discussionmentioning

confidence: 77%

Screening-detected and symptomatic untreated celiac children show similar gut microflora-associated characteristics

Tjellström

Stenhammar²,

Högberg³

et al. 2010

Scandinavian Journal of Gastroenterology

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Section: Discussionmentioning

confidence: 77%

Screening-detected and symptomatic untreated celiac children show similar gut microflora-associated characteristics

Tjellström

Stenhammar²,

Högberg³

et al. 2010

Scandinavian Journal of Gastroenterology

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“…Several of the clinical indications listed were more noticeable in the biopsy-negative group, namely, failure to thrive and other high-risk characteristics that might imply CD, such as diabetes mellitus type 1, hypertransaminasemia, and IgA deficiency. All these clinical symptoms may indeed suggest CD (12), but their higher occurrence within the biopsy-negative group intensifies the concept that CD is mainly asymptomatic and the majority of cases remain undiagnosed (7,9,10,16,30). Lurz et al (23) similarly presented failure to thrive as a more pronounced characteristic in the disease control group of highrisk children.…”

Section: Discussionmentioning

confidence: 99%

Performance of Serology Assays for Diagnosing Celiac Disease in a Clinical Setting

Parizade

Bujanover

Weiss

et al. 2009

Clin Vaccine Immunol

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Diagnosis of celiac disease frequently depends upon serology assays. We set out to prospectively assess the diagnostic value of five serology tests: an enzyme-linked immunosorbent assay (ELISA) for tissue transglutaminase (tTG)-immunoglobulin A (IgA) and tTG-IgG, a chemiluminescence assay for tTG-IgA, an ELISA for deamidated gliadin peptide (DGP) IgG and IgA screening, and detection of endomysial antibodies (Abs) by indirect immunofluorescence. One hundred sixteen children at high risk for developing celiac disease were evaluated clinically and underwent small bowel biopsies and blood serology tests. We examined differences between younger and older children in terms of clinical presentation, test performance, and the ability of high Ab levels to correctly predict diagnosis of celiac disease. Celiac disease was diagnosed for 85 (73%) children. No significant clinical differences were observed between the biopsy-positive and biopsy-negative groups. Children <3 years of age revealed higher concentrations of tTG-IgA and DGP Abs than children >3 years old (P ‫؍‬ 0.017 and 0.007, respectively). High Ab concentrations were predictive of villous atrophies, with sensitivities ranging from 92.8% to 97.9%, depending on the assay and the cutoff points applied. Sensitivities, specificities, positive predictive values, and negative predictive values varied among assays and improved after correction for best cutoff points. Assay specificities obtained in the clinical setting were lower than expected. The new tTG-IgA chemiluminescence assay demonstrated high throughput but low specificity (74.2%). The tTG-IgA ELISA exhibited the highest test efficiency, and the tTG-IgA chemiluminescence assay was suitable for large-scale screening, with reduced specificity. High concentrations of celiac disease-specific Abs bring into question the need for performance of biopsies on children at high risk.

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“…In Sweden, United Kingdom, and Germany the prevalence exceeded in some studies even 1.5% , Mustalahti 2010). However, many children, especially the asymptomatic ones, may remain undiagnosed (Ravikumara 2007). A Swedish screening study revealed that only 1/3 of children with CD had been clinically detected and diagnosed before serological testing (Myléus 2009).…”

Section: Epidemiology Prevalence Of CDmentioning

confidence: 99%

Demographics, clinical features and treatment of pediatric celiac disease

Tapsas¹

2015

Linköping University Medical Dissertations

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Celiac disease (CD) is a chronic small intestinal immune-mediated enteropathy triggered by ingestion of gluten-containing food in genetically predisposed subjects. The enteropathy is presented with a wide variety of clinical manifestations, which can occur even outside the gastrointestinal tract. In the majority of cases, the diagnosis of CD is based on a small intestinal biopsy showing mucosal alterations, i.e. intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy. The treatment, gluten-free diet (GFD), has recently been revised with the addition of gluten-free oats. Oats give a more diversified nutrition and increase the fibre content. The use of oats in CD is though still debated in some reports. A strict life-long adherence to the GFD can be problematic, especially for pediatric CD patients. Sweden reported of one of the highest observed CD prevalences worldwide, i.e. 3%, among 12-year-olds born during what has been described as "the Swedish celiac epidemic", 1984−1996.The aims of this thesis were to elucidate how pediatric CD has changed during a 41-year period in Sweden, i.e. 1973Sweden, i.e. −2013, in terms of clinical presentation, disease severity, incidence, and demographics. We also wanted to adress the compliance to the GFD, the use of oats in the GFD and the safety of oats inclusion in the diet by measuring urinary nitric oxide (NO) metabolites.Filed information provided data about 2856 pediatric patients investigated for suspected CD between 1973 and 2013; of which 1030 patients were diagnosed with CD. After the data analyses the mean age of CD patients was shown to increase after the celiac epidemic period.Currently, CD shows a less severe picture in terms of symptoms and intestinal pathology.Younger children suffer primarily from gastrointestinal symptoms and growth failure, whereas extra-intestinal manifestations are more often displayed among adolescents. viWe also reported an unusually high pediatric CD incidence rate and cumulative incidence, likely the highest reported worldwide. We hypothesised that the introduction of new antibody tests would affect the diagnostic activity and accuracy in performing small intestinal biopsies for CD investigation. However, the outcome of diagnostic activity and accuracy could not clearly be attributed to the use of antibody tests due to changes occurring in parallel during the 41-year study period, e.g. a different pattern of symptoms at presentation and improved knowledge of the disease among parents and health professionals.In a questionnaire-based study our patient group reported a high compliance to the GFD.Long duration of the GFD may, however, influence compliance negatively. Oats have been included to the GFD of our study population in most of the cases without reporting major complications related to their well-being.The urinary measurements of NO metabolites revealed two patient groups, one with high and one with low levels. The two populations did not differ regarding sex, age, compliance to the GFD or oats consumption. Fa...

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Ninety Percent of Celiac Disease Is Being Missed

Cited by 69 publications

References 19 publications

Screening-detected and symptomatic untreated celiac children show similar gut microflora-associated characteristics

Screening-detected and symptomatic untreated celiac children show similar gut microflora-associated characteristics

Performance of Serology Assays for Diagnosing Celiac Disease in a Clinical Setting

Demographics, clinical features and treatment of pediatric celiac disease

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