Stahl Marisa G, Pan Zhaoxing, Germone Monique, Nagle Sadie, Mehta Pooja, Shull Mary, Griffith Isabel, Shuler Brianne, Hoffenberg Edward, Taki Iman, Geno-Rasmussen Cristy, Rewers Marian J, Norris Jill M, Liu Edwin
Digestive Health Institute, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Child Health Research Biostatistics Core, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Clin Gastroenterol Hepatol. 2025 Jun;23(7):1135-1142. doi: 10.1016/j.cgh.2024.03.030. Epub 2024 Apr 13.
BACKGROUND & AIMS: Celiac disease (CD) mass screening remains controversial in part because of a paucity of data to support its benefit. The Autoimmunity Screening for Kids study is a mass screening study for pediatric CD and type 1 diabetes in Colorado.
This study prospectively follows up children ages 1 to 17 years who screened positive for tissue transglutaminase IgA autoantibodies in the Autoimmunity Screening for Kids study subsequently referred for diagnostic evaluation. Children diagnosed with CD by biopsy or serologic criteria were included in this study. Evaluation at baseline and 12 month follow-up evaluation included demographics, laboratory studies, symptoms, health-related quality of life, anxiety/depression, and gluten-free diet adherence. Paired Student t test, chi-square, and Wilcoxon signed-rank tests compared baseline and follow-up data. For symptom scores, odds of improvement were assessed.
Of the 52 children with CD enrolled, 42 children completed 12-month follow-up evaluation. On the symptom questionnaire completed at diagnostic evaluation, 38 of 42 children reported 1 or more symptoms. CD mean symptom severity and frequency scores improved from baseline to follow-up evaluation (P < .001). Reported health-related quality of life scores improved among caregivers (P = .002). There was no significant change in reported anxiety or depression. Iron deficiency without anemia was common at baseline (21 of 24 children; 87.5%) and normalized at follow-up evaluation (11 of 21 children; 52.3%). Twenty-six of 28 families reported good or excellent gluten-free diet adherence.
This novel study of children with CD identified through a mass screening program demonstrated improvement in symptoms, quality of life, and iron deficiency after 1 year follow-up evaluation. This demonstrates that there may be benefit to CD mass screening.
乳糜泻（CD）的大规模筛查仍存在争议，部分原因是缺乏支持其益处的数据。儿童自身免疫筛查研究是一项针对科罗拉多州儿童CD和1型糖尿病的大规模筛查研究。
本研究对在儿童自身免疫筛查研究中组织转谷氨酰胺酶IgA自身抗体筛查呈阳性、随后被转诊进行诊断评估的1至17岁儿童进行前瞻性随访。通过活检或血清学标准诊断为CD的儿童纳入本研究。基线评估和12个月随访评估包括人口统计学、实验室检查、症状、健康相关生活质量、焦虑/抑郁以及无麸质饮食依从性。采用配对学生t检验、卡方检验和威尔科克森符号秩检验比较基线和随访数据。对于症状评分，评估改善的几率。
在纳入的52例CD儿童中，42例儿童完成了12个月的随访评估。在诊断评估时完成的症状问卷中，42例儿童中有38例报告了1种或更多症状。从基线评估到随访评估，CD的平均症状严重程度和频率评分有所改善（P < .001）。照顾者报告的健康相关生活质量评分有所提高（P = .002）。报告的焦虑或抑郁情况无显著变化。基线时缺铁但无贫血情况常见（24例儿童中有21例；87.5%），随访评估时恢复正常（21例儿童中有11例；52.3%）。28个家庭中有26个报告无麸质饮食依从性良好或极佳。
这项通过大规模筛查项目识别出的CD儿童的新颖研究表明，经过1年的随访评估，症状、生活质量和缺铁情况有所改善。这表明CD大规模筛查可能有益。
