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Dr Hogen Esch and colleagues from the Netherlands screened 6127 asymptomatic children aged 2–4 years for celiac disease by anti-endomysium testing.
After 6 months, biopsies were performed in 57 seropositive children.
The research team found that 54% had villous atrophy, but 46%, all HLA-DQ2/DQ8 positive, had normal histology.
The team reduced the number of unnecessary biopsies after serological mass screening for celiac disease in asymptomatic young children by optimizing screening procedures.
The team compared different tests and optimizing their cut-off point.
 | | 54% had villous atrophy | | Alimentary Pharmacology & Therapeutics |
Screening samples were tested for anti-endomysium, tissue-transglutaminase, antigliadin and deamidated-gliadin-peptides antibodies.
The team determined serological persistence over time, and the persistence of anti-endomysium and anti-endomysium, and tissue-transglutaminase was determined by testing serological samples obtained at biopsy.
The researchers found that tissue-transglutaminase and anti-deamidated-gliadin-peptides correlated with anti-endomysium.
Optimization of standard cut-off points not only reduced unnecessary biopsies by 50–96% but also reduced sensitivity.
Anti-endomysium persisted in all celiac disease children, but in only 50% of the non-celiac disease children.
Tissue-transglutaminase persisted in 83% of celiac disease, but in only 15% of non-celiac disease children.
Dr Hogen Esch's team concluded, “Celiac disease antibodies may be present transiently in genetically predisposed children.”
“To avoid unnecessary biopsies, serological mass screening procedures may be improved by repeating anti-endomysium and/or tissue-transglutaminase in initially seropositive young children after 6 months, before proceeding to biopsy.”
“This may reduce the number of unnecessary biopsies that are performed.”
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