Opportunistic coeliac disease screening in undifferentiated presentations to paediatric acute care.
emergency department
potential coeliac disease
targeted screening
Journal
Journal of paediatrics and child health
ISSN: 1440-1754
Titre abrégé: J Paediatr Child Health
Pays: Australia
ID NLM: 9005421
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
revised:
15
05
2023
received:
28
04
2022
accepted:
16
05
2023
medline:
2
8
2023
pubmed:
29
5
2023
entrez:
29
5
2023
Statut:
ppublish
Résumé
Coeliac disease (CD) can remain undiagnosed due to absent/atypical symptoms. We evaluated screening for CD in undifferentiated paediatric patients in the emergency department (ED). Subjects were all patients presenting to a children's hospital ED during the study period who had blood taken. Plasma remaining after routine care was tested for tissue transglutaminase IgA (tTG IgA) and deamidated gliadin IgG (DGP IgG) antibodies. Patients with positive results were counselled and offered confirmatory testing, then gastroenterology review if warranted. An initial positive result for either DGP IgG or tTG IgA was found in 4.2% (44/1055). There was a normalisation of 76% (19/25) of positive DGP IgG and 44% (4/9) of tTG IgA results on repeat testing, which was not available in 27% (12/44). The prevalence of biopsy-confirmed CD was 0.7% (7/1055), including two new diagnoses and five subjects with known CD. Three likely cases could not be confirmed. All confirmed and likely cases were >10 years old. In children >10 years old, the prevalence of either biopsy-confirmed or likely CD was 3.3% (10/302). A family history of CD, growth concerns, recurrent abdominal pain and lethargy were associated with persistence of positive tests. Opportunistic testing for CD in ED requires further investigation as a CD screening strategy. Our results suggest optimal screening in this setting should be by initially testing for tTG IgA and total IgA in children >10 years old (minimising transiently positive tests). Transiently positive coeliac antibodies may also warrant further investigation as a predictor of future CD.
Substances chimiques
Transglutaminases
EC 2.3.2.13
Immunoglobulin A
0
Autoantibodies
0
Gliadin
9007-90-3
Immunoglobulin G
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
992-997Subventions
Organisme : Coeliac Australia
Informations de copyright
© 2023 The Authors. Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).
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