کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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5719389 | 1607415 | 2017 | 9 صفحه PDF | دانلود رایگان |
ObjectiveTo assess whether children at risk for celiac disease should be screened systematically by comparing their baseline and follow-up characteristics to patients detected because of clinical suspicion.Study designFive hundred four children with celiac disease were divided into screen-detected (nâ=â145) and clinically detected cohorts (nâ=â359). The groups were compared for clinical, serologic, and histologic characteristics and laboratory values. Follow-up data regarding adherence and response to gluten-free diet were compared. Subgroup analyses were made between asymptomatic and symptomatic screen-detected patients.ResultsOf screen-detected patients, 51.8% had symptoms at diagnosis, although these were milder than in clinically detected children (Pâ<â.001). Anemia (7.1% vs 22.9%, Pâ<â.001) and poor growth (15.7% vs 36.9%, Pâ<â.001) were more common, and hemoglobin (126âg/l vs 124âg/l, Pâ=â.008) and albumin (41.0âg/l vs 38.0âg/l, Pâ=â.016) were lower in clinically detected patients. There were no differences in serology or histology between the groups. Screen-detected children had better dietary adherence (91.2% vs 83.2%, Pâ=â.047). The groups showed equal clinical response (97.5% vs 96.2%, Pâ=â.766) to the gluten-free diet. In subgroup analysis among screen-detected children, asymptomatic patients were older than symptomatic (9.0â vs 5.8âyears of age, Pâ=â.007), but the groups were comparable in other variables.ConclusionsMore than one-half of the screen-detected patients with celiac disease had symptoms unrecognized at diagnosis. The severity of histologic damage, antibody levels, dietary adherence, and response to treatment in screen-detected cases is comparable with those detected on a clinical basis. The results support active screening for celiac disease among at-risk children.
Journal: The Journal of Pediatrics - Volume 183, April 2017, Pages 115-121.e2