Point-of-Care Screening for Coeliac Disease in Schoolchildren Reveals Higher Disease Prevalence in Croatia

Mario Mašić, Vera Musil, Tatjana Petričević Vidović, Enida Sičaja, Iva Hojsak, Oleg Jadrešin, Sanja Kolaček, Zrinjka Mišak, Mario Mašić, Vera Musil, Tatjana Petričević Vidović, Enida Sičaja, Iva Hojsak, Oleg Jadrešin, Sanja Kolaček, Zrinjka Mišak

Abstract

Coeliac disease (CD) is an immune-mediated inflammatory disease triggered by dietary gluten and related proteins in genetically predisposed individuals. Point-of-care (POC) methods are non-invasive and easily performed tests, which could help to reduce the diagnostic delay of CD. The aim of our study was to determine the prevalence of CD using rapid POC test in first-grade schoolchildren in Zagreb, Croatia. A rapid qualitative immunoassay POC test designed for detection of immunoglobulin (Ig) A and IgG deamidated gliadin antibodies (DGP), as well as total IgA (to identify IgA deficient patients) in whole blood, was used to test healthy children on gluten containing diet. Out of 1404 tested children (51% female), 85 (6.05%) had a positive rapid POC test result and were referred to paediatric gastroenterologist. Finally, 7 children were diagnosed with CD (0.5%). There was no significant difference in children with CD and children with positive POC but negative serology in sex, BMI, or symptoms. However, children diagnosed with CD complained of abdominal pain significantly more often. The prevalence of CD in first-grade schoolchildren was 1:200 (0.5%), higher than in previous studies performed in Croatia. The results imply the possible benefit of IgA and IgG DGP-based POC tests in population screening.

Keywords: child; coeliac disease; epidemiology; point-of-care testing.

Conflict of interest statement

The authors declare that there are no conflict of interest regarding the publication of this paper.

Figures

Figure 1
Figure 1
Flow chart of the screening.

References

    1. Ludvigsson J.F., Leffler D.A., Bai J.C., Biagi F., Fasano A., Green P.H.R., Hadjivassiliou M., Kaukinen K., Kelly C.P., Leonard J.N., et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013;62:43–52. doi: 10.1136/gutjnl-2011-301346.
    1. Guandalini S. The approach to Celiac Disease in children. Int. J. Pediatr. Adolesc. Med. 2017;4:124–127. doi: 10.1016/j.ijpam.2017.08.002.
    1. Green P.H., Lebwohl B., Greywoode R. Celiac disease. J. Allergy Clin. Immunol. 2015;135:1099–1106. doi: 10.1016/j.jaci.2015.01.044.
    1. Husby S., Koletzko S., Korponay-Szabó I.R., Mearin M.L., Phillips A., Shamir R., Troncone R., Giersiepen K., Branski D., Catassi C., et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J. Pediatr. Gastroenterol. Nutr. 2012;54:136–160. doi: 10.1097/MPG.0b013e31821a23d0.
    1. Tye-Din J., Galipeau H., Agardh D. Celiac Disease: A Review of Current Concepts in Pathogenesis, Prevention, and Novel Therapies. Front. Pediatr. 2018;6:350. doi: 10.3389/fped.2018.00350.
    1. Garampazzi A., Rapa A., Mura S., Capelli A., Valori A., Boldorini R., Oderda G. Clinical pattern of celiac disease is still changing. J. Pediatr. Gastroenterol. Nutr. 2007;45:611–614. doi: 10.1097/MPG.0b013e31814c3d79.
    1. Jericho H., Sansotta N., Guandalini S. Extraintestinal Manifestations of Celiac Disease: Effectiveness of the Gluten-Free Diet. J. Pediatr. Gastroenterol. Nutr. 2017;65:75–79. doi: 10.1097/MPG.0000000000001420.
    1. Husby S., Koletzko S., Korponay-Szabó I., Kurppa K., Mearin M.L., Ribes-Koninckx C., Shamir R., Troncone R., Auricchio R., Castillejo G., et al. European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. J. Pediatr. Gastroenterol. Nutr. 2020;70:141–156. doi: 10.1097/MPG.0000000000002497.
    1. Nadhem O.N., Azeez G., Smalligan R.D., Urban S. Review and practice guidelines for celiac disease in 2014. Postgrad. Med. 2015;127:259–265. doi: 10.1080/00325481.2015.1015926.
    1. Meijer C., Shamir R., Szajewska H., Mearin L. Celiac Disease Prevention. Front. Pediatr. 2018;6:368. doi: 10.3389/fped.2018.00368.
    1. Korponay-Szabó I.R., Szabados K., Pusztai J., Uhrin K., Ludmány É., Nemes É., Kaukinen K., Kapitány A., Koskinen L., Sipka S., et al. Population screening for coeliac disease in primary care by district nurses using a rapid antibody test: Diagnostic accuracy and feasibility study. BMJ. 2007;335:1244–1247. doi: 10.1136/bmj.39405.472975.80.
    1. Singh P., Arora A., Strand T.A., Leffler D.A., Mäki M., Kelly C.P., Ahuja V., Makharia G.K. Diagnostic Accuracy of Point of Care Tests for Diagnosing Celiac Disease: A Systematic Review and Meta-Analysis. J. Clin. Gastroenterol. 2019;53:535–542. doi: 10.1097/MCG.0000000000001081.
    1. Popp A., Jinga M., Jurcut C., Balaban V., Bardas C., Laurila K., Vasilescu F., Ene A., Anca I., Mäki M. Fingertip rapid point-of-care test in adult case-finding in coeliac disease. BMC Gastroenterol. 2013;13:115. doi: 10.1186/1471-230X-13-115.
    1. Khangura J., Van den Bruel A., Perera R., Heneghan C., Price C.P., Wolstenholme J., Thompson M., Plüddemann A. Point-of-care testing for coeliac disease: Primary care diagnostic technology update. Br. J. Gen. Pract. 2013;63:e426–e428. doi: 10.3399/bjgp13X668401.
    1. McAllister B.P., Williams E., Clarke K. A Comprehensive Review of Celiac Disease/Gluten-Sensitive Enteropathies. Clin. Rev. Allergy Immunol. 2019;57:226–243. doi: 10.1007/s12016-018-8691-2.
    1. Rubio-Tapia A., Ludvigsson J., Brantner T.L., Murray J., Everhart J.E. The prevalence of celiac disease in the United States. Am. J. Gastroenterol. 2012;107:1538–1544. doi: 10.1038/ajg.2012.219.
    1. Myléus A., Ivarsson A., Webb C., Danielsson L., Hernell O., Högberg L., Karlsson E., Lagerqvist C., Norström F., Rosén A., et al. Celiac disease revealed in 3% of Swedish 12-year-olds born during an epidemic. J. Pediatr. Gastroenterol. Nutr. 2009;49:170–176. doi: 10.1097/MPG.0b013e31818c52cc.
    1. Roberts S.E., Morrison-Rees S., Thapar N., Benninga M.A., Borrelli O., Broekaert I., Dolinsek J., Martin-De-Carpi J., Mas E., Miele E., et al. Systematic review and meta-analysis: The incidence and prevalence of paediatric coeliac disease across Europe. Aliment. Pharmacol. Ther. 2021;54:109–128. doi: 10.1111/apt.16337.
    1. Matek Z., Jungvirth-Hegedus M., Kolacek S. Epidemiology of coeliac disease in children in one Croatian county: The cumulative incidence over ten-year period and the way of clinical presentation (Part I) Coll. Antropol. 1999;23:621–628.
    1. Hegedus-Jungvirth M., Kolacek S., Zizic V. Rezultati skrininga o prevalenciji celijakije u odrasloj populaciji u Međimurju. Acta Med. Croat. 2001;55((Suppl. 4)):139.
    1. Baraba Dekanić K., Butorac Ahel I., Ružman L., Dolinšek J., Dolinšek J., Palčevski G. Is There a Role of Using a Rapid Finger Prick Antibody Test in Screening for Celiac Disease in Children? Gastroenterol. Res. Pract. 2019;2019:4504679. doi: 10.1155/2019/4504679.
    1. Benkebil F., Nydegger A. [Coeliac disease in children—An update] Rev. Med. Suisse. 2007;3:515–519.
    1. Lau M.S., Mooney P.D., White W.L., Rees M.A., Wong S.H., Kurien M., Trott N., Leffler D.A., Hadjivassiliou M., Sanders D.S. The Role of an IgA/IgG-Deamidated Gliadin Peptide Point-of-Care Test in Predicting Persistent Villous Atrophy in Patients with Celiac Disease on a Gluten-Free Diet. Am. J. Gastroenterol. 2017;112:1859–1867. doi: 10.1038/ajg.2017.357.
    1. Singh P., Arora A., Strand T.A., Leffler D.A., Catassi C., Green P.H., Kelly C.P., Ahuja V., Makharia G.K. Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clin. Gastroenterol. Hepatol. 2018;16:823–836.e2. doi: 10.1016/j.cgh.2017.06.037.
    1. Lionetti E., Catassi C. New clues in celiac disease epidemiology, pathogenesis, clinical manifestations, and treatment. Int. Rev. Immunol. 2011;30:219–231. doi: 10.3109/08830185.2011.602443.
    1. Gujral N., Freeman H.J., Thomson A.B. Celiac disease: Prevalence, diagnosis, pathogenesis and treatment. World J. Gastroenterol. 2012;18:6036–6059. doi: 10.3748/wjg.v18.i42.6036.
    1. Popp A., Mäki M. Changing Pattern of Childhood Celiac Disease Epidemiology: Contributing Factors. Front. Pediatr. 2019;7:357. doi: 10.3389/fped.2019.00357.
    1. Lionetti E., Gatti S., Pulvirenti A., Catassi C. Celiac disease from a global perspective. Best Pract. Res. Clin. Gastroenterol. 2015;29:365–379. doi: 10.1016/j.bpg.2015.05.004.
    1. Yuan J., Zhou C., Gao J., Li J., Yu F., Lu J., Li X., Wang X., Tong P., Wu Z., et al. Prevalence of Celiac Disease Autoimmunity Among Adolescents and Young Adults in China. Clin. Gastroenterol. Hepatol. 2017;15:1572–1579.e1. doi: 10.1016/j.cgh.2017.04.025.
    1. Ress K., Luts K., Rägo T., Pisarev H., Uibo O. Nationwide study of childhood celiac disease incidence over a 35-year period in Estonia. Eur. J. Pediatr. 2012;171:1823–1828. doi: 10.1007/s00431-012-1835-0.
    1. Ramakrishna B.S., Makharia G.K., Chetri K., Dutta S., Mathur P., Ahuja V., Amarchand R., Balamurugan R., Chowdhury S.D., Daniel D., et al. Prevalence of Adult Celiac Disease in India: Regional Variations and Associations. Am. J. Gastroenterol. 2016;111:115–123. doi: 10.1038/ajg.2015.398.
    1. Kondrashova A., Mustalahti K., Kaukinen K., Viskari H., Volodicheva V., Haapala A.-M., Ilonen J., Knip M., Mäki M., Hyoty H., et al. Lower economic status and inferior hygienic environment may protect against celiac disease. Ann. Med. 2008;40:223–231. doi: 10.1080/07853890701678689.
    1. Ben Hariz M., Laadhar L., Kallel-Sellami M., Siala N., Bouraoui S., Bouziri S., Borgi A., Karouia F., Maherzi A., Makni S. Celiac disease in Tunisian children: A second screening study using a “new generation” rapid test. Immunol. Investig. 2013;42:356–368. doi: 10.3109/08820139.2013.770012.
    1. Grode L., Jensen T.M., Parkner T., Agerholm I.E., Humaidan P., Bech B.H., Ramlau-Hansen C. Diagnostic Accuracy of a Point-of-Care Test for Celiac Disease Antibody Screening among Infertile Patients. Inflamm. Intest. Dis. 2019;4:123–130. doi: 10.1159/000501520.
    1. Raivio T., Kaukinen K., Nemes E., Laurila K., Collin P., Kovács J.B., Maki M., Korponay-Szabo I.R. Self transglutaminase-based rapid coeliac disease antibody detection by a lateral flow method. Aliment. Pharmacol. Ther. 2006;24:147–154. doi: 10.1111/j.1365-2036.2006.02957.x.
    1. Tangermann P., Branchi F., Itzlinger A., Aschenbeck J., Schubert S., Maul J., Liceni T., Schröder A., Heller F., Spitz W., et al. Low Sensitivity of Simtomax Point of Care Test in Detection of Celiac Disease in a Prospective Multicenter Study. Clin. Gastroenterol. Hepatol. 2019;17:1780–1787.e5. doi: 10.1016/j.cgh.2018.09.032.
    1. Riznik P., De Leo L., Dolinsek J., Gyimesi J., Klemenak M., Koletzko B., Koletzko S., Korponay-Szabó I.R., Krencnik T., Not T., et al. Clinical Presentation in Children with Coeliac Disease in Central Europe. J. Pediatr. Gastroenterol. Nutr. 2020;72:546–551. doi: 10.1097/MPG.0000000000003015.
    1. Sahin Y. Celiac disease in children: A review of the literature. World J. Clin. Pediatr. 2021;10:53–71. doi: 10.5409/wjcp.v10.i4.53.
    1. Smith L.B., Lynch K.F., Kurppa K., Koletzko S., Krischer J., Liu E., Johnson S.B., Agardh D., TEDDY Study Group Psychological Manifestations of Celiac Disease Autoimmunity in Young Children. Pediatrics. 2017;139:e20162848. doi: 10.1542/peds.2016-2848.
    1. Green P.H., Fleischauer A.T., Bhagat G., Goyal R., Jabri B., Neugut A. Risk of malignancy in patients with celiac disease. Am. J. Med. 2003;115:191–195. doi: 10.1016/S0002-9343(03)00302-4.
    1. Makharia G.K., Singh P., Catassi C., Sanders D.S., Leffler D., Ali R.A.R., Bai J.C. The global burden of coeliac disease: Opportunities and challenges. Nat. Rev. Gastroenterol. Hepatol. 2022;19:313–327. doi: 10.1038/s41575-021-00552-z.
    1. Ludvigsson J.F., Card T., Kaukinen K., Bai J., Zingone F., Sanders D.S., Murray J. Screening for celiac disease in the general population and in high-risk groups. United Eur. Gastroenterol. J. 2015;3:106–120. doi: 10.1177/2050640614561668.
    1. Van Koppen E.J., Schweizer J.J., Csizmadia C.G., Krom Y., Hylkema H.B., van Geel A.M., Koopman H.M., Verloove-Vanhorick S.P., Mearin M.L. Long-term health and quality-of-life consequences of mass screening for childhood celiac disease: A 10-year follow-up study. Pediatrics. 2009;123:e582–e588. doi: 10.1542/peds.2008-2221.
    1. Mustalahti K., Lohiniemi S., Collin P., Vuolteenaho N., Laippala P., Maki M. Gluten-free diet and quality of life in patients with screen-detected celiac disease. Eff. Clin. Pract. 2002;5:105–113.
    1. Paavola S., Kurppa K., Huhtala H., Saavalainen P., Lindfors K., Kaukinen K. Coeliac disease re-screening among once seronegative at-risk relatives: A long-term follow-up study. United Eur. Gastroenterol. J. 2022;10:585–593. doi: 10.1002/ueg2.12255.
    1. Riznik P., De Leo L., Dolinsek J., Gyimesi J., Klemenak M., Koletzko B., Koletzko S., Koltai T., Korponay-Szabó I.R., Krencnik T., et al. The Knowledge About Celiac Disease Among Healthcare Professionals and Patients in Central Europe. J. Pediatr. Gastroenterol. Nutr. 2021;72:552–557. doi: 10.1097/MPG.0000000000003019.

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