Improving Outcomes for Celiac Disease Through Mass Screening

Research study background

Celiac disease, one of the most common pediatric autoimmune diseases, is increasing in prevalence. Yet, diagnosis is delayed for many children due to the rise in atypical or asymptomatic presentations. The U.S. Preventative Services Task Force maintains there is not yet enough evidence to recommend screening for celiac disease in asymptomatic individuals despite support for targeted screening by many pediatric gastroenterology societies and findings of potential benefits in European studies.

Researchers at Children’s Hospital Colorado evaluated health-related outcomes of children identified with celiac disease through the Autoimmunity Screening for Kids (ASK) study and followed for one year on a gluten-free diet. The Barbara Davis Center for Diabetes at the University of Colorado Anschutz Medical Campus is the lead site for ASK. Since 2017, ASK has screened more than 33,000 children in Colorado and now nationally for type 1 diabetes and celiac disease.

This study describes 52 children with confirmed transglutaminase IgA autoantibodies through ASK who were seen at the Colorado Center for Celiac Disease at Children’s Colorado between January 2019 and March 2022. These children were diagnosed with celiac disease based on ESPGHAN serologic or biopsy criteria. Researchers collected data at a baseline assessment before treatment and 12 months after treatment. Forty-two children completed the one-year follow-up. Of those, 29 initially reported no gastrointestinal symptoms during their ASK screening. However, at their baseline clinic visit, all but two reported one or more symptoms on the extended symptom questionnaire.

Among children who completed both symptom surveys, 85.5% had symptom frequency improvement and 79.5% had symptom severity improvement compared to baseline. Twenty-eight families continued a gluten-free diet with a registered dietitian and all but two reported good or excellent adherence and a decrease in transglutaminase IgA autoantibodies.

Most children had low ferritin at the baseline visit and more than half improved to normalized levels at follow-up. In addition, parents reported significant improvements in their child’s quality of life and there was no increase in caregiver and child self-reported symptoms of anxiety and depression from screening to follow-up.

Clinical implications

Children identified through mass screening showed improvement after treatment in initially unrecognized symptoms, health-related quality of life and iron deficiency, without an increase in anxiety and depression. This study is the first in the U.S. to show the benefits of screening, diagnosis and treatment through a mass celiac disease screening program. Study authors noted that while more research is needed on the cost-effectiveness and long-term outcomes of mass screening before policy recommendations can be made, these results add to the growing body of evidence.