Mass Screening is the Only Way to Find Celiac Disease in All Children

Celiac.com 01/11/2021 - A team of researchers recently reported celiac disease outcomes and other data for about ten thousand of the first children screened by  Autoimmunity Screening for Kids (ASK), a large scale pediatric screening study in Colorado for celiac disease and type 1 diabetes. 

The research team included Marisa G Stahl, Cristy Geno Rasmussen, Fran Dong, Kathleen Waugh, Jill M Norris, Judith Baxter, Liping Yu, Andrea K Steck, Brigitte I Frohnert, Edwin Liu, Marian J Rewers, and the ASK Study Group.

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They are variously affiliated with the Department of Pediatrics, Digestive Health Institute, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; the Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; and the Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

ASK uses two highly sensitive tests to screen for tissue transglutaminase autoantibodies (TGA) in children aged 1-17 years for celiac disease. The first is a radiobinding (RBA) test for IgA TGA, while the second is an electrochemiluminescence (ECL) test that detects all TGA isotypes. 

Children who test positive on either screen are asked to come back for a confirmation test. Children with confirmed RBA TGA levels at or above 0.1, which is twice the upper limit of normal, are sent to the Colorado Center for Celiac Disease for additional assessment, while all others are referred to primary care.

Blood screens of the first 9,973 children showed 242 children (about 2.4%) with positive TGA by either test. Of those who tested positive, 185 (76.4%) received follow-up blood confirmation, while 149 (80.5%) were confirmed positive for celiac disease via RBA TGA. 

About 70 percent of children identified through screening did not have symptoms and about 90 percent did not have a family history, though they did tend to be of non-Hispanic white ethnicity, and generally of the female sex. 

Gastrointestinal symptoms of celiac disease, as measured on initial screening, were equally common among the RBA TGA+ vs TGA- children.

The initial results of this ongoing mass-screening program reveal a high rates of undiagnosed celiac disease autoimmunity in a significant US population. 

Based on their results, the study team concludes that “Universal screening seems to be the only way to detect all cases of celiac disease and has the potential to reduce diagnostic delay and associated morbidity."

Read more in Am J Gastroenterol. 2021 Jan 1;116(1):180-187.