TY - JOUR
T1 - The identification of celiac disease in asymptomatic children
T2 - the Generation R Study
AU - Jansen, Michelle A E
AU - van Zelm, Menno
AU - Groeneweg, Michael
AU - Jaddoe, Vincent W V
AU - Dik, Willem A.
AU - Schreurs, Marco W J
AU - Hooijkaas, Herbert
AU - Moll, Henriette
AU - Escher, Johanna C.
PY - 2018/3
Y1 - 2018/3
N2 - Background: The objective of our study was to assess whether TG2A levels in the healthy childhood population can be predictive of subclinical CD. Methods: A total of 4442 children (median age, 6.0 years) participating in a population-based prospective cohort study were screened on serum TG2A. Those with positive TG2A (≥7 U/ml; n = 60, 1.4%) were invited for clinical evaluation (median age, 9.0 years). Medical history, physical examination, serum TG2A, and IgA-endomysium (EMA) were assessed, as well as HLA DQ 2.2/2.5/8 typing. Patients with positive serologies and genetic risk types underwent duodenal biopsies. TG2A levels at the time of biopsy were compared with the degree of enteropathy. Results: Fifty-one TG2A-positive children were included in the follow-up: 31 (60.8%) children had CD, ten (19.6%) did not have CD, and ten (19.6%) were considered potential CD cases because of inconclusive serologies. Duodenal biopsies were performed in 26/31 children. CD with Marsh 3a/b enteropathy was observed in 75% (15/20) of children having TG2A levels ≥10ULN at 6 years of age, as well as in 75% (6/8) of children having a positive TG2A <10 ULN (OR 1.00; 95% CI 0.15–6.64). CD cases had a lower BMI SDS (mean −0.49, SD 0.92) than children without CD (mean 0.47, SD 1.37; p = 0.02). No differences were observed in gastrointestinal symptoms. Conclusions: Serum TG2A screening at 6 years of age in the healthy childhood population has a positive predictive value of 61% to detect subclinical CD. We did not find a positive correlation between serum TG2A levels and the degree of enteropathy.
AB - Background: The objective of our study was to assess whether TG2A levels in the healthy childhood population can be predictive of subclinical CD. Methods: A total of 4442 children (median age, 6.0 years) participating in a population-based prospective cohort study were screened on serum TG2A. Those with positive TG2A (≥7 U/ml; n = 60, 1.4%) were invited for clinical evaluation (median age, 9.0 years). Medical history, physical examination, serum TG2A, and IgA-endomysium (EMA) were assessed, as well as HLA DQ 2.2/2.5/8 typing. Patients with positive serologies and genetic risk types underwent duodenal biopsies. TG2A levels at the time of biopsy were compared with the degree of enteropathy. Results: Fifty-one TG2A-positive children were included in the follow-up: 31 (60.8%) children had CD, ten (19.6%) did not have CD, and ten (19.6%) were considered potential CD cases because of inconclusive serologies. Duodenal biopsies were performed in 26/31 children. CD with Marsh 3a/b enteropathy was observed in 75% (15/20) of children having TG2A levels ≥10ULN at 6 years of age, as well as in 75% (6/8) of children having a positive TG2A <10 ULN (OR 1.00; 95% CI 0.15–6.64). CD cases had a lower BMI SDS (mean −0.49, SD 0.92) than children without CD (mean 0.47, SD 1.37; p = 0.02). No differences were observed in gastrointestinal symptoms. Conclusions: Serum TG2A screening at 6 years of age in the healthy childhood population has a positive predictive value of 61% to detect subclinical CD. We did not find a positive correlation between serum TG2A levels and the degree of enteropathy.
KW - Celiac disease
KW - Child
KW - Cohort study
KW - Screening
KW - Tissue transglutaminase type 2 antibodies
UR - http://www.scopus.com/inward/record.url?scp=85020268109&partnerID=8YFLogxK
U2 - 10.1007/s00535-017-1354-x
DO - 10.1007/s00535-017-1354-x
M3 - Article
AN - SCOPUS:85020268109
SN - 0944-1174
VL - 53
SP - 377
EP - 386
JO - Journal of Gastroenterology
JF - Journal of Gastroenterology
IS - 3
ER -