The identification of celiac disease in asymptomatic children

the Generation R Study

Michelle A E Jansen, Menno van Zelm, Michael Groeneweg, Vincent W V Jaddoe, Willem A. Dik, Marco W J Schreurs, Herbert Hooijkaas, Henriette Moll, Johanna C. Escher

Research output: Contribution to journalArticleResearchpeer-review

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Abstract

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.

Original languageEnglish
Pages (from-to)377-386
Number of pages10
JournalJournal of Gastroenterology
Volume53
Issue number3
DOIs
Publication statusPublished - Mar 2018

Keywords

  • Celiac disease
  • Child
  • Cohort study
  • Screening
  • Tissue transglutaminase type 2 antibodies

Cite this

Jansen, M. A. E., van Zelm, M., Groeneweg, M., Jaddoe, V. W. V., Dik, W. A., Schreurs, M. W. J., ... Escher, J. C. (2018). The identification of celiac disease in asymptomatic children: the Generation R Study. Journal of Gastroenterology, 53(3), 377-386. https://doi.org/10.1007/s00535-017-1354-x
Jansen, Michelle A E ; van Zelm, Menno ; Groeneweg, Michael ; Jaddoe, Vincent W V ; Dik, Willem A. ; Schreurs, Marco W J ; Hooijkaas, Herbert ; Moll, Henriette ; Escher, Johanna C. / The identification of celiac disease in asymptomatic children : the Generation R Study. In: Journal of Gastroenterology. 2018 ; Vol. 53, No. 3. pp. 377-386.
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title = "The identification of celiac disease in asymptomatic children: the Generation R Study",
abstract = "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.",
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Jansen, MAE, van Zelm, M, Groeneweg, M, Jaddoe, VWV, Dik, WA, Schreurs, MWJ, Hooijkaas, H, Moll, H & Escher, JC 2018, 'The identification of celiac disease in asymptomatic children: the Generation R Study', Journal of Gastroenterology, vol. 53, no. 3, pp. 377-386. https://doi.org/10.1007/s00535-017-1354-x

The identification of celiac disease in asymptomatic children : the Generation R Study. / Jansen, Michelle A E; van Zelm, Menno; Groeneweg, Michael; Jaddoe, Vincent W V; Dik, Willem A.; Schreurs, Marco W J; Hooijkaas, Herbert; Moll, Henriette; Escher, Johanna C.

In: Journal of Gastroenterology, Vol. 53, No. 3, 03.2018, p. 377-386.

Research output: Contribution to journalArticleResearchpeer-review

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

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U2 - 10.1007/s00535-017-1354-x

DO - 10.1007/s00535-017-1354-x

M3 - Article

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JO - Journal of Gastroenterology

JF - Journal of Gastroenterology

SN - 0944-1174

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