Clinical Features of Children With Screening-Identified Evidence of Celiac Disease

• Published in: Pediatrics (Evanston) Vol. 113; no. 5; pp. 1254 - 1259
• Main Authors: Hoffenberg, Edward J, Emery, Lisa M, Barriga, Katherine J, Bao, Fei, Taylor, Jennifer, Eisenbarth, George S, Haas, Joel E, Sokol, Ronald J, Taki, Iman, Norris, Jill M, Rewers, Marian
• Format: Journal Article
• Language: English
• Published: Elk Grove Village, IL Am Acad Pediatrics 01-05-2004; American Academy of Pediatrics
• Subjects: Autoantibodies - blood; Biological and medical sciences; Biopsy; Body Mass Index; Case-Control Studies; Celiac disease; Celiac Disease - diagnosis; Child, Preschool; Children; Children & youth; Diagnosis; Diseases; Fundamental and applied biological sciences. Psychology; Gastrointestinal diseases; General aspects; Genetics of eukaryotes. Biological and molecular evolution; Growth; Humans; Immune system; Immunoglobulin A - immunology; Immunoglobulins; Infant; Malabsorption syndromes; Mass Screening; Medical examination; Medical sciences; Medical screening; Molecular and cellular biology; Nutrition Assessment; Pediatric diseases; Pediatrics; Risk factors; Transglutaminases - immunology; United States; Europe; Denver Colorado; United States > US; Human; Autoimmunity; Immunopathology; Pediatrics; transglutaminase; IgA; screening; Enzyme; Transferases; Clinical form; Coeliac disease; Medical screening; Aminoacyltransferases; Body mass index; Symptomatology; Intestinal malabsorption; children; celiac disease; Digestive diseases; Intestinal disease; Genetics; Protein-glutamine γ-glutamyltransferase; Child
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.113.5.1254

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.
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.
Compared with 100 age- and gender-matched TG-negative controls, 18 TG-positive children, 5.5 +/- 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.
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.