Clinical features of children with screening-identified evidence of celiac disease

Objective. At-risk groups commonly undergo screening for autoantibodies associated with celiac disease (CD). However, the clinical significance of a positive test remains uncertain. The objective of this study was to evaluate growth and clinical features of children who test positive for an autoantibody associated with CD. Methods. A case-control study of Denver area healthy infants and young children with and without CD autoantibodies was conducted. A cohort of HLA-characterized children were followed prospectively since birth for the development of immunoglobulin A antitissue transglutaminase autoantibodies (TG). Clinical evaluation, questionnaire, blood draw, and small bowel biopsy were performed. Growth and nutrition and frequency of positive responses were measured. Results. Compared with 100 age- and gender-matched TG-negative controls, 18 TG-positive children, 5.5 [+ or -] 0.5 years of age, had a greater number of symptoms and lower z scores for weight-for-height and for body mass index. Responses that were independently associated with TG-positive status were irritability/lethargy, abdominal distention/gas, and difficulty with weight gain. Conclusions. Screening-identified TG-positive children demonstrate mild alterations in growth and nutrition and report more symptoms than control subjects. Additional study is needed on the benefit and risk of identifying CD in at-risk groups. Pediatrics 2004;113: 1254-1259; celiac disease, IgA, transglutaminase, children, body mass index, autoimmunity, screening. ABBREVIATIONS. CD, celiac disease; EMA, endomysial antibodies; TG, transglutaminase antibodies; IgA, immunoglobulin A; BMI, body mass index; OR, odds ratio; CI, confidence interval.
Evidence of celiac disease (CD) may be present in 1 in every 100 to 250 children, (1,2) adolescents, (3) and adults (4,5) in Europe and the United States. (6) Individuals [...]