Symptoms tell too little

By Van Waffle

Summary: Mass screening remains a costly, controversial option for identifying the large proportion of people with celiac disease who remain undiagnosed. A nationwide screening of all 12-year-old Swedish students assessed whether a questionnaire could adequately substitute for blood tests.

All students were invited to participate. If parents consented, children filled out questionnaires about symptoms. Parents also filled out a separate questionnaire including information about family history of celiac disease. More than 7,500 children participated, with 7,200 of them giving blood samples. Those undiagnosed children showing markers for celiac disease received a biopsy for confirmation. This identified 153 new cases of undiagnosed celiac disease.

But the study found no correlation between symptoms reported by the children and diagnosis. Children who reported problems like stomach ache and tiredness were no more likely to be diagnosed with celiac disease. Notably, children who reported no related symptoms were just as likely as those with symptoms to have undiagnosed celiac disease, the blood test results showed.

Conclusion: A questionnaire about celiac disease symptoms would not contribute to an effective screening program for children. Symptoms are such poor indicators that doctors should avoid prescribing a restrictive gluten-free diet for children on this basis without further diagnosis.


[1] “Usefulness of symptoms to screen for celiac disease”, Rosén A, Sandström O, Carlsson A, Högberg L, Olén O, Stenlund H, Ivarsson A, #Pediatrics# 2014 Jan 13 {Epub] doi: 10.1542/peds.2012-3765

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