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29-03-2011 | Gastroenterology | Article

Celiac disease screening program may be feasible

Abstract

Free abstract

MedWire News: Findings from a US community-based study demonstrate that undiagnosed celiac disease is a readily identifiable and "relatively" common condition in the general population.

The authors report that a blood test-based celiac disease screening program was not only "widely accepted" by the study cohort, but also predicted disease positivity with an acceptable degree of accuracy.

To investigate the feasibility of a celiac disease screening program, Joseph Murray (Mayo Clinic, Rochester, Minnesota) and colleagues recruited 3850 adults from Natrona County in Wyoming to undergo blood testing for tissue transglutaminase antibodies (tTG-IgA) and endomysial antibody (EMA) - indicators of celiac disease positivity.

All participants were Wyoming Health Fair attendees with no known history of celiac disease.

The team reports in the American Journal of Gastroenterology that 31 (0.8%) participants tested positive for both serologic indicators of celiac disease and were subsequently offered a small bowel biopsy to confirm the condition. Of these individuals, 18 accepted, and the biopsy results of all but one (94%) showed histologic evidence of celiac disease, such as partial villous atrophy and crypt hyperplasia.

This, say Murray and team, indicates that "the positive-predictive value for biopsy-confirmed celiac disease of this sequential serologic testing strategy was 94% for celiac disease."

The assessment of gastrointestinal (GI) symptoms, such as constipation, diarrhea, and heartburn, among all of the participants revealed no positive correlation between celiac disease seropositivity and any individual GI symptom.

"One of the major concerns regarding screening protocols in the general population is the likelihood of false-positive results that may lead to unnecessary invasive evaluations," say the researchers.

They highlight, however, that this issue is minimized by the high positive-predictive value associated with the tTG-IgA/EMA serologic test.

They conclude: "The who, when, and if screening of the general population are justified are still unanswered and require further study."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Lauretta Ihonor