Dr Ilma Korponay-Szabó and colleagues from Hungery evaluated the feasibility and diagnostic accuracy of screening for celiac disease by rapid detection of immunoglobulin A antibodies to tissue transglutaminase in primary care.
District nurses screened 6 year old children using rapid antibody testing of finger prick blood.
|Rapid testing had a 100% specificity|
|British Medical Journal|
The team also collected capillary blood samples for laboratory determination of immunoglobulin A and G antibodies to endomysium and immunoglobulin A antibodies to tissue transglutaminase.
Children with positive rapid test results were directly sent for biopsy of the small intestine.
The research team evaluated 2690 children, and 120 nurses.
Positivity for antibodies to endomysium or transglutaminase in the laboratory and celiac disease was confirmed at biopsy.
The team found that less than 2% of children had biopsy confirmed celiac disease.
Only 5 of these children had been diagnosed clinically before screening.
Rapid testing had a 78% sensitivity, and 100% specificity for a final diagnosis of celiac disease.
The team found sensitivity was 65%, and specificity was 100% compared with combined results of immunoglobulin A and G laboratory tests.
Trained laboratory workers detected 30 of the 31 newly diagnosed immunoglobulin A competent patients with the rapid test kit used blindly.
Median time to biopsy after a positive rapid test result was significantly shorter than after a positive laboratory result.
The research team found that children with celiac disease detected at screening were smaller and had a worse health status than their peers.
However, children with celiac disease improved on a gluten-free diet.
Dr Korponay-Szabó's team concluded, "A simple rapid antibody test enabled primary care nurses to detect patients with celiac disease in the community who were not picked up in clinical care."
"Extra training is needed to improve sensitivity."