Five-year follow-up of new cases after a coeliac disease mass screening

This Swedish study of children screened for coeliac disease and followed up five years later showed that around a third with positive serology but normal biopsy had since developed coeliac disease. Conversely, very few children with negative serology became coeliac. Objective We previously performed a population-based mass screening of coeliac disease in children aged 12 years in two birth cohorts resulting in 296 seropositive children, of whom 242 were diagnosed with coeliac disease after duodenal biopsies. In this follow-up study, we wanted to identify new cases in the screening population that tested negative-either converting from potential coeliac disease (seropositive but normal duodenal mucosa) or converting from seronegative at screening to diagnosed coeliac disease. Methods All seropositive children were invited to a follow-up appointment 5 years after the screening with renewed serological testing and recommended endoscopic investigation if seropositive. Seronegative children in the screening study (n=12 353) were linked to the National Swedish Childhood Coeliac Disease Register to find cases diagnosed in healthcare during the same period. Results In total, 230 (77%) came to the follow-up appointment, including 34 of 39 with potential coeliac disease. Of these, 11 (32%) had converted to coeliac disease. One new case was found in the National Swedish Childhood Coeliac Disease Register who received the diagnosis through routine screening in children with type 1 diabetes. Conclusions There is a high risk of conversion to coeliac disease among those with potential disease. However, a negative screening test was associated with a very low risk for a clinical diagnosis within a follow-up period of 5 years.
Funding Agencies|Umea University; European UnionEuropean Commission [FP6-2005-FOOD-4B-36383-PREVENTCD]; Swedish Research CouncilSwedish Research CouncilEuropean Commission [521-2004-7093, 521-2007-2953]; Swedish Research Council for Environment, Agricultural Sciences and Spatial PlanningSwedish Research Council Formas [222-2004-1918, 222-2007-1394]; Swedish Council for Working Life and Social ResearchSwedish Research CouncilSwedish Research Council for Health Working Life & Welfare (Forte) [2005-0802]; Vasterbotten County Council [RV-238151]