Mass Screening for Celiac Disease: The Autoimmunity Screening for Kids Study : Official journal of the American College of Gastroenterology | ACG

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Mass Screening for Celiac Disease: The Autoimmunity Screening for Kids Study

Stahl, Marisa G. MD, MSCS1; Geno Rasmussen, Cristy PhD, MPH2; Dong, Fran MS2; Waugh, Kathleen MS2; Norris, Jill M. PhD, MPH3; Baxter, Judith MA2; Yu, Liping MD2; Steck, Andrea K. MD2; Frohnert, Brigitte I. MD, PhD2; Liu, Edwin MD1; Rewers, Marian J. MD, PhD2;  the ASK Study Group

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The American Journal of Gastroenterology 116(1):p 180-187, January 2021. | DOI: 10.14309/ajg.0000000000000751



The Autoimmunity Screening for Kids (ASK) study is a large scale pediatric screening study in Colorado for celiac disease (CD) and type 1 diabetes. This is a report of the CD outcomes for the first 9,973 children screened through ASK.


ASK screens children aged 1–17 years for CD using 2 highly sensitive assays for tissue transglutaminase autoantibodies (TGA): a radiobinding (RBA) assay for IgA TGA and an electrochemiluminescence (ECL) assay that detects all TGA isotypes. Children who test positive on either assay are asked to return for confirmatory testing. Those with a confirmed RBA TGA level ≥ 0.1 (twice the upper limit of normal) are referred to the Colorado Center for Celiac Disease for further evaluation; all others are referred to primary care.


Of the initial 9,973 children screened, 242 children were TGA+ by any assay. Of those initially positive, 185 children (76.4%) have completed a confirmation blood draw with 149 children (80.5%) confirming positive by RBA TGA. Confirmed RBA TGA+ was associated with a family history of CD (odds ratio [OR] = 1.83; 95% confidence interval 1.06–3.16), non-Hispanic white ethnicity (OR = 3.34; 2.32–4.79), and female sex (OR = 1.43; 1.03–1.98). Gastrointestinal symptoms of CD, assessed at the initial screening, were reported equally often among the RBA TGA+ vs TGA− children (32.1% vs 30.5%, P = 0.65).


The initial results of this ongoing mass-screening program confirm a high prevalence of undiagnosed CD autoimmunity in a screened US population. Symptoms at initial screening were not associated with TGA status (see Visual abstract, Supplementary Digital Content 5,

© 2020 by The American College of Gastroenterology

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