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Magazzù G, Aquilina S, Barbara C, Bondin R, Brusca I, Bugeja J, Camilleri M, Cascio D, Costa S, Cuzzupè C, Duca A, Fregapane M, Gentile V, Giuliano A, Grifò A, Grima AM, Ieni A, Li Calzi G, Maisano F, Melita G, Pallio S, Panasiti I, Pellegrino S, Romano C, Sorce S, Tabacchi ME, Taormina V, Tegolo D, Tortora A, Valenti C, Vella C, Raso G. Recognizing the Emergent and Submerged Iceberg of the Celiac Disease: ITAMA Project-Global Strategy Protocol. Pediatr Rep 2022; 14:293-311. [PMID: 35736659 PMCID: PMC9227897 DOI: 10.3390/pediatric14020037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/19/2022] [Accepted: 06/06/2022] [Indexed: 12/12/2022] Open
Abstract
Coeliac disease (CD) is frequently underdiagnosed with a consequent heavy burden in terms of morbidity and health care costs. Diagnosis of CD is based on the evaluation of symptoms and anti-transglutaminase antibodies IgA (TGA-IgA) levels, with values above a tenfold increase being the basis of the biopsy-free diagnostic approach suggested by present guidelines. This study showcased the largest screening project for CD carried out to date in school children (n=20,000) aimed at assessing the diagnostic accuracy of minimally invasive finger prick point-of-care tests (POCT) which, combined with conventional celiac serology and the aid of an artificial intelligence-based system, may eliminate the need for intestinal biopsy. Moreover, this study delves deeper into the "coeliac iceberg" in an attempt to identify people with disorders who may benefit from a gluten-free diet, even in the absence of gastrointestinal symptoms, abnormal serology and histology. This was achieved by looking for TGA-IgA mucosal deposits in duodenal biopsy. This large European multidisciplinary health project paves the way to an improved quality of life for patients by reducing the costs for diagnosis due to delayed findings of CD and to offer business opportunities in terms of diagnostic tools and support.
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Affiliation(s)
- Giuseppe Magazzù
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
- Correspondence:
| | - Samuel Aquilina
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Christopher Barbara
- Department of Pathology, Mater Dei Hospital, 2090 Msida, Malta; (C.B.); (M.C.)
| | - Ramon Bondin
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Ignazio Brusca
- Ospedale Fatebenefratelli, Buccheri La Ferla, 90123 Palermo, Italy; (I.B.); (M.F.)
| | | | - Mark Camilleri
- Department of Pathology, Mater Dei Hospital, 2090 Msida, Malta; (C.B.); (M.C.)
| | - Donato Cascio
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Stefano Costa
- DAI Materno-Infantile, AOU Policlinico G. Martino, 98124 Messina, Italy; (S.C.); (S.P.)
| | - Chiara Cuzzupè
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Annalise Duca
- AcrossLimits Ltd., 4013 Birkirkara, Malta; (J.B.); (A.D.); (A.G.)
| | - Maria Fregapane
- Ospedale Fatebenefratelli, Buccheri La Ferla, 90123 Palermo, Italy; (I.B.); (M.F.)
| | - Vito Gentile
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Angele Giuliano
- AcrossLimits Ltd., 4013 Birkirkara, Malta; (J.B.); (A.D.); (A.G.)
| | - Alessia Grifò
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Anne-Marie Grima
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Antonio Ieni
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Giada Li Calzi
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Fabiana Maisano
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Giuseppinella Melita
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Socrate Pallio
- Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, 98122 Messina, Italy;
| | - Ilenia Panasiti
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Salvatore Pellegrino
- DAI Materno-Infantile, AOU Policlinico G. Martino, 98124 Messina, Italy; (S.C.); (S.P.)
| | - Claudio Romano
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Salvatore Sorce
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
- Facoltà di Ingegneria e Architettura, Università degli Studi di Enna “Kore”, 94100 Enna, Italy
| | - Marco Elio Tabacchi
- Dipartimento di Matematica e Informatica, Università di Palermo, 90133 Palermo, Italy; (M.E.T.); (D.T.); (C.V.)
| | - Vincenzo Taormina
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Domenico Tegolo
- Dipartimento di Matematica e Informatica, Università di Palermo, 90133 Palermo, Italy; (M.E.T.); (D.T.); (C.V.)
| | - Andrea Tortora
- DAI Scienze Mediche, AOU Policlinico G. Martino, 98124 Messina, Italy;
| | - Cesare Valenti
- Dipartimento di Matematica e Informatica, Università di Palermo, 90133 Palermo, Italy; (M.E.T.); (D.T.); (C.V.)
| | - Cecil Vella
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Giuseppe Raso
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
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Primavera G, Aiello A, Grosso C, Trifirò G, Costa S, Grima A, Pallio S, Toumi M, Magazzu’ G, Pellegrino S, Agnello V, Cacioppo E, Di Leonardo F, Ippolito G, Marciante G, Montalbano I, Montalbano V, Pennino D, Sanfilippo E, Testoni M, Gulino A, Libranti M, Cambria R, Nibali SC, Crupi I, Ferro C, Maiolino MG, Paparone S, Scaffidi M, Siracusano MF, Ventura M, Aloisio A, Amoroso B, D’Andrea C, Di Matteo M, Dieli M, Gennaro A, Lo Cascio A, Lo Iacono G, Rinaudo B, Quattrocchi O, Conti MT, Genovese R, Linguanti G, Miccichè A, Panasia S, Occhipinti A, Muccioli P, Benenati L, Cappello N, Cusenza V, Giacalone G, Lo Cascio D, Parrinello A, Cavataio F, Spina M, Malandrino S, Comisi F, D’Andrea P, Macdonnell T. Point-of-Care test screening versus Case finding for paediatric coeliac disease: A pragmatic study in primary care. Acta Paediatr 2021; 110:337-339. [PMID: 32740955 DOI: 10.1111/apa.15514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | | | | | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging University of Messina Messina Italy
| | | | - Anne‐Marie Grima
- Department of Child and Adolescent Health Mater Dei Hospital Msida Malta
| | - Socrate Pallio
- Digestive Endoscopy Unit University of Messina Messina Italy
| | - Mondher Toumi
- Faculty of Medicine Public Health Department Aix‐Marseille University Marseille France
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Khalesi M, Jafari SA, Kiani M, Picarelli A, Borghini R, Sadeghi R, Eghtedar A, Ayatollahi H, Kianifar HR. In Vitro Gluten Challenge Test for Celiac Disease Diagnosis. J Pediatr Gastroenterol Nutr 2016. [PMID: 26196202 DOI: 10.1097/mpg.0000000000000917] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The in vitro gluten challenge test is an important diagnostic modality in celiac disease (CD), especially in patients who begin treatment with a gluten-free diet before adequate diagnostic workup or in cases with atypical CD. Available literature was reviewed regarding the accuracy of the in vitro gluten challenge test for CD diagnosis. METHODS MEDLINE, Scopus, and Google Scholar were searched, and studies that used serology and bowel biopsy as the criterion standard for diagnosis were included in our study. Data on authors, publication year, characteristics of the patient and control groups, patients' diet, duration of the gluten challenge test, histology findings, endomysial antibody (EMA) and anti-tissue transglutaminase (tTG) levels, CD markers, and intercellular cell adhesion molecule-1, and human leukocyte antigens before and after the gluten challenge test were extracted. RESULTS Overall, 15 studies were included in this meta-analysis. Pooled sensitivity %/specificity % was 84/99 for EMA after the challenge, 52/96 for EMA without the challenge, 95.5/98.3 for anti-tTG after the challenge, and 95.1/98.3 for anti-tTG without the challenge test. Sensitivity/specificity for immunological markers were 89/97 for the percentage of CD25⁺-lamina propria lymphocytes, 96/91 for the percentage of CD3⁺-lamina propria lymphocytes, and 96.1/85.7 for the percentage of intercellular cell adhesion molecule-1-lamina propria lymphocytes. The factors that increased the sensitivity of EMA were longer test duration, and the evaluation of patients on a gluten-containing diet or short-term gluten-free diet. CONCLUSIONS The in vitro gluten challenge test can be a useful part of the diagnostic workup of CD, rather than only a model to evaluate its mechanisms.
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Affiliation(s)
- Maryam Khalesi
- *Department of Pediatrics†Department of Pediatric Gastroenterology, Faculty of Medicine, Ghaem Medical Center, Mashhad University of Medical Sciences, Mashhad, Iran‡Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy§Nuclear Medicine Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Hematology/Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI¶Department of Hematopathology and Blood banking, Faculty of Medicine, Ghaem Medical Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Al Hatlani MM. Prevalence of celiac disease among symptom-free children from the Eastern Province of Saudi Arabia. Saudi J Gastroenterol 2015; 21:367-71. [PMID: 26655131 PMCID: PMC4707804 DOI: 10.4103/1319-3767.170952] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND/AIM Epidemiological studies of celiac disease (CD) among Saudi children have been performed only within some groups who are at a high risk of developing CD. The aim of this study was to determine the prevalence of CD among symptom-free children from the public schools of the military campus of National Guard in the Eastern Province of Saudi Arabia. PATIENTS AND METHODS Between 2012 and 2014, serum samples were collected from 1141 students (age 6-18 years) attending nine public schools of the military campus of National Guard in the Eastern Province of Saudi Arabia. Participants were screened for CD by testing for anti-tissue transglutaminase IgA (IgA-tTG) and IgG antibodies (IgG-tTG). Small intestinal biopsy was offered to all participants who tested positive for IgA-tTG [IgA-tTG >20 relative units (RU)/ml]. RESULTS Of the 1141 participants, 32 were IgA-tTG positive. Thus, the estimated serology-positive prevalence was 3%. An intestinal biopsy was performed in 10 of the participants with antibody positivity. The biopsy findings of all 10 children were consistent with CD. Thus, the estimated biopsy-confirmed prevalence was about 1%. CONCLUSIONS The prevalence of CD was estimated to be about 1% among symptom-free children from the public schools of the military campus of National Guard in the Eastern Province of Saudi Arabia.
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Affiliation(s)
- Maher M. Al Hatlani
- Department of Pediatrics, Ministry of National Guard, King Abdullah International Medical Research Center, King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia,Address for correspondence: Dr. Maher M. Al Hatlani, Department of Pediatrics, Ministry of National Guard, King Abdullah International Medical Research Center, King Abdullah Specialized Children Hospital, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. E-mail:
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Costa S, Astarita L, Ben-Hariz M, Currò G, Dolinsek J, Kansu A, Magazzu' G, Marvaso S, Micetic-Turku D, Pellegrino S, Primavera G, Rossi P, Smarrazzo A, Tucci F, Arcidiaco C, Greco L. A point-of-care test for facing the burden of undiagnosed celiac disease in the Mediterranean area: a pragmatic design study. BMC Gastroenterol 2014; 14:219. [PMID: 25518884 PMCID: PMC4296530 DOI: 10.1186/s12876-014-0219-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/11/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We aimed at assessing the factors that can influence results of the dissemination of an already validated, new generation commercial Point-of-Care Test (POCT) for detecting celiac disease (CD), in the Mediterranean area, when used in settings where it was designed to be administered, especially in countries with poor resources. METHODS Pragmatic study design. Family pediatricians at their offices in Italy, nurses and pediatricians in Slovenia and Turkey at pediatricians', schools and university primary care centers looked for CD in 3,559 (1-14 yrs), 1,480 (14-23 yrs) and 771 (1-18 yrs) asymptomatic subjects, respectively. A new generation POCT detecting IgA-tissue antitransglutaminase antibodies and IgA deficiency in a finger-tip blood drop was used. Subjects who tested positive and those suspected of having CD were referred to a Celiac Centre to undergo further investigations in order to confirm CD diagnosis. POCT Positive Predictive Value (PPV) at tertiary care (with Negative Predictive Value) and in primary care settings, and POCT and CD rates per thousand in primary care were estimated. RESULTS At tertiary care setting, PPV of the POCT and 95% CI were 89.5 (81.3-94.3) and 90 (56-98.5) with Negative Predictive Value 98.5 (94.2-99.6) and 98.7% (92-99.8) in children and adults, respectively. In primary care settings of different countries where POCT was performed by a different number of personnel, PPV ranged from 16 to 33% and the CD and POCT rates per thousand ranged from 4.77 to 1.3 and from 31.18 to 2.59, respectively. CONCLUSIONS Interpretation of POCT results by different personnel may influence the performance of POC but dissemination of POCT is an urgent priority to be implemented among people of countries with limited resources, such as rural populations and school children.
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Affiliation(s)
- Stefano Costa
- Celiac Regional Center, Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - Luca Astarita
- European Laboratory for Food Induced Diseases, University of Naples Federico II, Naples, Italy.
| | - Mongi Ben-Hariz
- Pediatric Unit, Mongi SLIM's Hospital of Tunis, Marsa, Tunisia.
| | - Giovanni Currò
- Celiac Regional Center, Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - Jernej Dolinsek
- University Medical Centre Pediatric Department, Ljubljanska, Maribor, Slovenia.
| | - Aydan Kansu
- Faculty of Medicine, Department of Pediatric Gastroenterology, Ankara University, Ankara, Turkey.
| | - Giuseppe Magazzu'
- Celiac Regional Center, Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - Stefania Marvaso
- Celiac Regional Center, Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | | | - Salvatore Pellegrino
- Celiac Regional Center, Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - Giuseppe Primavera
- National Health System, Azienda Sanitaria Locale 6, Associazione Culturale Pediatri, Palermo, Italy.
| | - Pasqualino Rossi
- Directorate General for European and International Relations, Ministry of Health, Rome, Italy.
| | - Andrea Smarrazzo
- European Laboratory for Food Induced Diseases, University of Naples Federico II, Naples, Italy.
| | - Francesca Tucci
- European Laboratory for Food Induced Diseases, University of Naples Federico II, Naples, Italy.
| | - Carmela Arcidiaco
- European Laboratory for Food Induced Diseases, University of Naples Federico II, Naples, Italy.
| | - Luigi Greco
- European Laboratory for Food Induced Diseases, University of Naples Federico II, Naples, Italy. .,Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy.
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