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A study finds CD serological screening tests may not be as sensitive as
thought, thus missing many cases of CD where only partial villous atrophy
is present. And another study supports the notion that CD begins in
childhood. A previous study in the UK found the prevalence of CD in
children at age 7 similar to that of adults in the UK. Now a study of
children under 3 years in Spain also shows a CD prevalence similar to that
of adults, and this at a younger age than the UK study.
In previous posts to the Celiac List, I have cited articles suggesting that
the mix of gut flora significantly affects development of the immune system
in infants. If there is a connection between gut bacteria and CD, then CD
research needs to look at the intestinal flora of infants.
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Dig Dis Sci. 2004 Apr;49(4):546-50
Seronegative celiac disease: increased prevalence with lesser degrees of
villous atrophy.
Abrams JA, Diamond B, Rotterdam H, Green PH.
Department of Medicine, Columbia University College of Physicians and
Surgeons, New York, New York, USA.
Our aim was to assess differences in the sensitivities of serologic tests
used for the diagnosis of celiac disease among patients with varying
degrees of villous atrophy. Among 115 adults with biopsy-proven celiac
disease who fulfilled strict criteria, including serologic testing at the
time of diagnosis and response to a gluten-free diet, 71% had total villous
atrophy and 29% partial villous atrophy. Endomysial antibody was positive
in 77% of those with total villous atrophy, compared to 33% with partial
villous atrophy (P < 0.001). There was no difference in sensitivity when
the type of presentation (classical vs. silent) was compared. Endomysial
antibody-positive and negative patients did not differ with respect to age
at diagnosis, duration of symptoms, mode of presentation, or family history
of celiac disease. All anti-tissue transglutaminase-positive patients had
TVA on biopsy. Seronegative celiac disease occurs. Endomysial antibody
positivity correlates with more severe villous atrophy and not mode of
presentation of celiac disease. Serologic tests, in clinical practice, lack
the sensitivity reported in the literature.
PMID: 15185855 [PubMed - in process]
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J Pediatr Gastroenterol Nutr. 2004 Jul;39(1):80-84
Prospective Population Screening for Celiac Disease: High Prevalence in the
First 3 Years of Life.
Castano L, Blarduni E, Ortiz L, Nunez J, Bilbao JR, Rica I, Martul P,
Vitoria JC.
Endocrinology and Diabetes Research and Pediatric Units, Hospital de
Cruces, Barakaldo, Hospital de Zumarraga and Hospital de Mendaro, Basque
Country, Spain; Departments of Pediatrics, Nursing and Medicine, University
of the Basque Country, Bilbao, Basque Country, Spain.
BACKGROUND:: Celiac disease (CD) is an autoimmune enteropathy that develops
in genetically susceptible individuals exposed to gliadin. Early diagnosis
of CD may reduce the risk of complications, and several studies have
related the duration of gluten exposure to the risk of other autoimmune
diseases. It has been proposed that silent CD be diagnosed as soon as
possible to avoid potential complications. OBJECTIVES:: The purpose of this
study was to determine the prevalence of CD among children less than 3
years and to provide treatment to those patients diagnosed with CD.
PATIENTS AND METHODS:: Parents of 1100 healthy children born between
October 1998 and December 1999 were asked at the time of delivery to enroll
their children in a program for the early diagnosis of CD. The parents of
830 children agreed to participate. Patients in the study were examined and
anti-tissue transglutaminase antibody was first measured at about 1.5 years
of age. A second antibody titer was obtained at about 2.5 years of age.
Patients with detectable autoantibodies underwent intestinal biopsy for
confirmation of CD. RESULTS:: Of the 830 children initially enrolled, 613
and 484 returned for the first and second visits, respectively. None had
anti-tissue transglutaminase antibodies at the first visit, but 9 had anti-
tissue transglutaminase immunoglobulins at the second visit. In 7 of these
9, intestinal biopsy confirmed the diagnosis of CD which suggests a minimum
prevalence of CD of 1 per 118 healthy newborns. CONCLUSIONS:: The authors
observed a very high prevalence of CD, comparable to that observed in other
European populations, which might even be higher if all of the children
initially examined had returned for their second visit. If general
screening for CD were accepted, the authors would recommend age 2-3 years
as the best time for measuring tissue transglutaminase antibodies.
PMID: 15187786 [PubMed - as supplied by publisher]
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