Point‐of‐Care test screening versus Case finding for paediatric coeliac disease: A pragmatic study in primary care

Abstract

In paediatric coeliac disease (CD), symptoms may not be a reliable factor in the diagnosis of coeliac disease as described by Rosen et al, 1 and thus, recommendations for reviewing CD screening criteria were suggested. 2 Apart from the costs, an important limiting factor in paediatric population mass screening using conventional immunoglobulin (Ig) A tissue transglutaminase (tTGIgA) may be the low compliance of asymptomatic children to be referred for testing. On the other hand, the alternative approach, the CF strategy, relies on

Recognizing the Emergent and Submerged Iceberg of the Celiac Disease: ITAMA Project—Global Strategy Protocol

“…The results from the latter were coupled with an avant-garde CDSS system to define a strategy for making the diagnosis easier, less invasive, and feasible. Moreover, this project's exploration of the hypothetical deep roots of the "coeliac iceberg" has been made possible, uncovering many disorders that may be prevented by recognizing a pathogenetic relationship with gluten [14].…”

“…A different approach by Meijer-Boekel et al [13] performed a case finding project to detect CD children who visit the Youth Health Care Centres in the Netherlands to evaluate whether it is feasible, cost-effective, and well accepted by the population [13]. A study compared these two different approaches and concluded that a mass screening through POCT seemed more convenient than a case finding strategy, based on symptoms, that otherwise can miss asymptomatic children [14]. For optimal results as a screening tool, the POCT must have a high negative-predictive value in order to avoid missing cases.…”

“…This paper has been partially supported by the ITAMA project under the international cooperation program INTERREG V-A (JS-Code C1-1. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The content of this publication does not reflect the official opinion of the European Union.…”

“…A case study in the Netherlands Youth Health Care Centres, using a POCT to assess TGA-IgA, highlighted the fact that untreated CD has a considerable health burden on society [13]. Moreover, a preceding study had suggested that a mass screening using POCTs may be a useful and economic option for screening asymptomatic children and seems more convenient than a case finding strategy based on symptoms [14], contrary to what is observed in adults [15]. A literature review [12] showed that a critical point for using a POCT as screening tool is to define, with very narrow confidence limits, the negative predictive values of a test validated in a prospective way and to determine the reference standard to all subjects to whom a test has to be applied.…”

Diagnostic accuracy of a novel point‐of‐care test for simultaneous detection of anti‐transglutaminase IgA and anti‐deamidated gliadin IgG antibodies

“…In the last decade, several POCTs detecting mostly anti-tTG IgA have been developed, but their role remains unclear in clinical practice either as a mass screening tool or, in a case-finding strategy, as a first-line instrument to be used in at-risk individuals before the use of conventional serology. [12][13][14][15][16][17] Previous studies have shown variable sensitivity or specificity of these tests compared with the conventional serology, even if a recent systematic review and meta-analysis reported a high pooled sensitivity and specificity of POCTs in diagnosing CD (94% and 94.4%, respectively). 18 The primary aim of this study was to assess the diagnostic accuracy of a novel anti-tTG IgA/anti-DGP IgG-based POCT, compared with conventional serology (reference) methods in people with CD or suspected for CD.…”