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PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1254-1259

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

Edward J. Hoffenberg, MD*, Lisa M. Emery, MSPH{ddagger}, Katherine J. Barriga, MSPH{ddagger}, Fei Bao§, Jennifer Taylor, MD§, George S. Eisenbarth, MD, PhD§, Joel E. Haas, MD||, Ronald J. Sokol, MD*, Iman Taki, BS{ddagger}, Jill M. Norris, PhD{ddagger} and Marian Rewers, MD, PhD{ddagger},§

* Departments of Pediatrics
{ddagger} Preventive Medicine and Biometrics
|| Pathology
§ Barbara Davis Center for Childhood Diabetes, Children’s Hospital, and the University of Colorado School of Medicine, Denver, Colorado

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 ± 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.

Key Words: 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

Received for publication Mar 18, 2003; Accepted Jul 7, 2003.




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