One Year Outcomes Among Children Identified With Celiac Disease Through A Mass Screening Program

BACKGROUND

Celiac disease (CD) mass screening remains controversial in part because of a paucity of data to support its benefit. The Autoimmunity Screening for Kids (ASK) study is a mass screening study for pediatric CD and type 1 diabetes in Colorado.

METHODS

This study prospectively follows children ages 1-17 years who screened positive for tissue transglutaminase IgA autoantibodies (tTGA) in the ASK 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 included demographics, laboratory studies, symptoms, health-related quality of life (HRQoL), anxiety/depression, and gluten-free diet (GFD) adherence. Paired student-t, chi-square, and Wilcoxon sign rank tests compared baseline and follow up data. For symptom scores, odds of improvement were assessed.

RESULTS

Of the 52 children with CD enrolled, 42 children completed 12-month follow up. On the symptom questionnaire completed at diagnostic evaluation, 38/42 children reported one or more symptoms. CD mean symptom severity and frequency scores improved from baseline to follow up (p <0.001). Reported HRQoL scores improved among caregivers (p=0.002). There was no significant change in reported anxiety or depression. Iron deficiency without anemia was common at baseline (21/24 children, 87.5%) and normalized at follow up (11/21 children, 52.3%). 26/28 families reported good or excellent GFD adherence.

CONCLUSIONS

This novel study of children with CD identified through a mass screening program demonstrated improvement in symptoms, quality of life, and iron deficiency after one year follow up. This demonstrates that there may be benefit to CD mass screening.

Population level screening for celiac disease: is now the time?

PURPOSE OF REVIEW

As incidence and prevalence of celiac disease is increasing, subclinical and asymptomatic presentations are more commonly identified through celiac disease screening. However, the United States Preventive Services Task Force released a statement in 2017 maintaining that there is insufficient evidence to recommend general population screening for celiac disease for asymptomatic individuals. This review summarizes the current available evidence on celiac disease screening.

RECENT FINDINGS

Literature demonstrates that by limiting screening to individuals with recognized symptoms, celiac disease diagnosis is frequently delayed or missed entirely. Most individuals with screening-identified celiac disease have previously unrecognized symptoms that improve through treatment with a gluten-free diet. Screening-identified individuals also demonstrate signs of impaired nutrition, growth, bone health, and quality of life which improve with treatment. Overall, celiac disease screening is viewed favorably by those identified through celiac disease screening programs.

SUMMARY

Individuals with screening-identified celiac disease may still incur complications from untreated disease and receive benefit from treatment with a gluten-free diet. More data is needed to determine the cost effectiveness of different mass screening approaches that incorporate the societal perspective towards screening.

Mucosal Inflammatory and Wound Healing Gene Programs Reveal Targets for Stricturing Behavior in Pediatric Crohn's Disease

BACKGROUND AND AIMS

Ileal strictures are the major indication for resective surgery in Crohn's disease (CD). We aimed to define ileal gene programs present at diagnosis linked with future stricturing behavior during five year follow-up, and to identify potential small molecules to reverse these gene signatures.

METHODS

Antimicrobial serologies and pre-treatment ileal gene expression were assessed in a representative subset of 249 CD patients within the RISK multicenter pediatric CD inception cohort study, including 113 that are unique to this report. These data were used to define genes associated with stricturing behavior and for model testing to predict stricturing behavior. A bioinformatics approach to define small molecules which may reverse the stricturing gene signature was applied.

RESULTS

19 of the 249 patients developed isolated B2 stricturing behavior during follow-up, while 218 remained B1 inflammatory. Using deeper RNA sequencing than in our prior report, we have now defined an inflammatory gene signature including an oncostatin M co-expression signature, tightly associated with extra-cellular matrix (ECM) gene expression in those who developed stricturing complications. We further computationally prioritize small molecules targeting macrophage and fibroblast activation and angiogenesis which may reverse the stricturing gene signature. A model containing ASCA and CBir1 serologies and a refined eight ECM gene set was significantly associated with stricturing development by year five after diagnosis (AUC (95th CI) = 0.82 (0.7-0.94)).

CONCLUSION

An ileal gene program for macrophage and fibroblast activation is linked to stricturing complications in treatment naïve pediatric CD, and may inform novel small molecule therapeutic approaches.