Case Finding for Celiac Disease With a Point-of-Care Test

Abstract

Background/objectives: Celiac disease (CD) is underdiagnosed and thus untreated in many cases. Untreated CD may be associated with severe health complications, increased morbidity and mortality, and considerable burdens to health care systems. Our objectives were to prospectively assess whether implementation of case finding in young children at the Dutch Preventive Youth Health Care Centers (YHCCs) is feasible and effective.

Methods: From February 2019 to January 2022, parents of all children aged 1-4 years attending the YHCCs in the Kennemerland region were invited. If there was at least 1 CD-associated symptom, a point-of-care test was performed onsite to assess the (immunoglobulin [Ig] A/IgG/IgM) celiac autoantibodies against tissue transglutaminase type 2 (TGA). If positive, the child was referred for confirmation of the diagnosis if TGA-IgA was more than 7 times the upper limit of normal or if histopathology showed Marsh 2 or 3 in addition to positive autoantibodies against endomysium.

Results: A total of 16 289 parents were invited for regular consultation, of whom 14 917 consented to fill in the questionnaire; 5301 (35.5%) reported symptoms. A total of 3203 tests were performed in 3103 children (58.5%; 47.8% female; median age 2.0 y) and was positive in 61 (1.9%). CD was confirmed in 56 children (1.7% [95% CI, 1.46-2.44]; median age 2.6 y). With the exception of abdominal distention (P = .036), symptoms were similarly frequent among children with and without CD. The overall crude incidence rate of CD diagnosed by case finding was 1.67 per 1000 person-years (95% CI, 1.27-2.15), significantly higher than by standard of care (0.14 per 1000 person-years; P < .001).

Conclusion: Case finding for CD using a point-of-care test is effective and feasible at Dutch Preventive YHCCs. Implementation of case finding into the standard of care will lead to timely diagnosis of CD in childhood.