PDF(Pubmed)
Abstract：
BACKGROUND: Strategies for diagnosing celiac disease (CD) include case-finding and population-screening programs. Case finding consists of testing individuals at increased risk for the disease due to symptoms or associated conditions. Screening programs are widespread campaigns, which definitely perform better in terms of unveiling CD diagnoses but nowadays are still debatable. The global prevalence of CD is around 1% but it almost doubles when considering screening programs among school children. Within this framework, we aimed to estimate the prevalence of CD among hospitalized children in the Pediatric Department of a Southern Italy University Hospital in the period from January 2018 through December 2021. In addition, we attempted to explore, at the time of diagnosis, the prevalence of leading clinical alerts due to malabsorption/malnutrition such as anemia or failure to thrive or due to systemic inflammation/immune dysfunction as hypertransaminasemia and thyroid dysfunction.
METHODS: Data records of pediatric patients admitted as inpatients and tested by anti-transglutaminase IgA antibodies (TGA-IgA) were retrospectively analyzed. CD was diagnosed according to either 2012 or 2020 ESPGHAN guidelines, depending on the year of diagnosis. CD autoimmunity (CDA) was a wider group defined within our protocol if patients had elevated TGA-IgA on at least one occasion, regardless of anti-endomysial antibodies (EMA-IgA) and without biopsy confirmation.
RESULTS: During the observation period, 3608 pediatric patients were admitted and 1320 were screened for CD (median age 5 years, IQR 2-9 years; CD test rate: 36.6% out of all admissions). The available prevalence of newly diagnosed CD was 1.59% (21 patients diagnosed) and the available prevalence of CDA was 3.86% (51 subjects). Among CD patients, underweight/malnourished children accounted for 28.6% (6 out of 21).
CONCLUSIONS: The estimated prevalence of CD diagnoses within our setting was comparable to the most recent population-screening programs. The estimated prevalence of CDA was even higher. A hospital-admission CD testing during routine blood draws might be a non-invasive, cost-effective and valuable approach to reduce discrepancy of prevalence between case-finding and population-screening programs.
METHODS: Data records of pediatric patients admitted as inpatients and tested by anti-transglutaminase IgA antibodies (TGA-IgA) were retrospectively analyzed. CD was diagnosed according to either 2012 or 2020 ESPGHAN guidelines, depending on the year of diagnosis. CD autoimmunity (CDA) was a wider group defined within our protocol if patients had elevated TGA-IgA on at least one occasion, regardless of anti-endomysial antibodies (EMA-IgA) and without biopsy confirmation.
RESULTS: During the observation period, 3608 pediatric patients were admitted and 1320 were screened for CD (median age 5 years, IQR 2-9 years; CD test rate: 36.6% out of all admissions). The available prevalence of newly diagnosed CD was 1.59% (21 patients diagnosed) and the available prevalence of CDA was 3.86% (51 subjects). Among CD patients, underweight/malnourished children accounted for 28.6% (6 out of 21).
CONCLUSIONS: The estimated prevalence of CD diagnoses within our setting was comparable to the most recent population-screening programs. The estimated prevalence of CDA was even higher. A hospital-admission CD testing during routine blood draws might be a non-invasive, cost-effective and valuable approach to reduce discrepancy of prevalence between case-finding and population-screening programs.
摘要：
背景：诊断乳糜泻（CD）的策略包括病例发现和人群筛查计划。病例发现包括测试由于症状或相关疾病而导致疾病风险增加的个体。筛查计划是广泛的运动，在发布CD诊断方面肯定表现更好，但如今仍有争议。CD的全球患病率约为1％，但考虑到学童的筛查计划时，它几乎翻了一番。在这个框架内,我们旨在评估2018年1月至2021年12月意大利南部大学医院儿科住院儿童中CD的患病率.此外,我们试图探索，在诊断时，由于吸收不良/营养不良，如贫血或未能茁壮成长，或由于全身性炎症/免疫功能障碍，如高转氨酶血症和甲状腺功能障碍引起的主要临床警报的患病率。
方法：对住院患儿的数据记录进行回顾性分析，并进行抗谷氨酰胺转氨酶IgA抗体（TGA-IgA）检测。根据2012年或2020年ESPGHAN指南诊断CD，取决于诊断年份。如果患者至少有一次TGA-IgA升高，则CD自身免疫（CDA）是我们方案中定义的更广泛的组，无论抗子宫内膜抗体（EMA-IgA）和未经活检证实。
结果：在观察期间，3608名儿科患者入院，1320名患者接受CD筛查(中位年龄5岁，IQR2-9年；CD测试率：占所有录取人数的36.6%）。新诊断CD的可用患病率为1.59％（诊断为21例），CDA的可用患病率为3.86％（51例受试者）。在CD患者中，体重不足/营养不良儿童占28.6%(21人中有6人)。
结论：在我们的环境中，估计的CD诊断患病率与最近的人群筛查计划相当。CDA的估计患病率甚至更高。常规抽血期间入院时的CD检测可能是非侵入性的，减少病例发现和人群筛查计划之间患病率差异的具有成本效益和有价值的方法。
方法：对住院患儿的数据记录进行回顾性分析，并进行抗谷氨酰胺转氨酶IgA抗体（TGA-IgA）检测。根据2012年或2020年ESPGHAN指南诊断CD，取决于诊断年份。如果患者至少有一次TGA-IgA升高，则CD自身免疫（CDA）是我们方案中定义的更广泛的组，无论抗子宫内膜抗体（EMA-IgA）和未经活检证实。
结果：在观察期间，3608名儿科患者入院，1320名患者接受CD筛查(中位年龄5岁，IQR2-9年；CD测试率：占所有录取人数的36.6%）。新诊断CD的可用患病率为1.59％（诊断为21例），CDA的可用患病率为3.86％（51例受试者）。在CD患者中，体重不足/营养不良儿童占28.6%(21人中有6人)。
结论：在我们的环境中，估计的CD诊断患病率与最近的人群筛查计划相当。CDA的估计患病率甚至更高。常规抽血期间入院时的CD检测可能是非侵入性的，减少病例发现和人群筛查计划之间患病率差异的具有成本效益和有价值的方法。
