Childhood Coeliac Disease: An Iceberg in the Netherlands

Childhood coeliac disease: towards an improved serological mass screening strategy

“…Follow-up biopsies established a prevalence of otherwise unrecognized CD of 0.25-0.5% (1:200-400). 6 Besides the serologically detected…”

“…Large-scale screening studies in the general population have shown a CD prevalence of nearly 0.5-1.0% in both adults and children. [4][5][6] In spite of the disorder's prevalence, a majority of CD cases remain unrecognized and thus untreated. This is partly caused by the variable clinical presentation of CD, which ranges from a clear malabsorption syndrome with diarrhoea and failure-to-thrive in children to less specific symptoms, such as anaemia, osteoporosis or infertility.…”

“…10 Serological screening provides a non-invasive tool to detect CD in patients at risk and has also been used to assess the prevalence of CD in the general population. 5,6,11,12 Clinical paediatric studies have shown the specificity of both EmA and tTGA for gluten-sensitive enteropathy to be nearly 100%, with a sensitivity ranging from 90% to 100%. 10 Both IgA AGA and IgG AGA have sensitivity and specificity values of 80-90% and are therefore not regularly used for the detection of CD.…”

“…6 Parents of 57 (76%) of the 75 children with EmA positivity gave informed consent for performing small-bowel biopsies. The mean time interval between screening for EmA and performing biopsy was 6 months (AE2).…”

Defining the contribution of the HLA region to cis DQ2-positive coeliac disease patients

“…1,2 The disease is characterized by lesions of the small intestine with partial to total villous atrophy, crypt hyperplasia and invasion of lymphocytes into the gut epithelium and lamina propria. 3,4 The main clinical symptoms include chronic diarrhoea and growth retardation, but abdominal pain, anaemia, osteopenia and chronic fatigue may also occur.…”