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Symptoms and biomarkers associated with celiac disease: evaluation of a population-based screening program in adults

Kårhus, Line L.; Thuesen, Betina H.; Rumessen, Jüri J.; Linneberg, Allan

European Journal of Gastroenterology & Hepatology: November 2016 - Volume 28 - Issue 11 - p 1298–1304
doi: 10.1097/MEG.0000000000000709
Original Articles: Coeliac Disease

Objectives To identify possible early predictors (symptoms and biomarkers) of celiac disease, compare symptoms before and after screening, and evaluate the diagnostic efficacy of serologic screening for celiac disease in an adult Danish population.

Methods This cross-sectional population-based study was based on the 5-year follow-up of the Health2006 cohort, where 2297 individuals were screened for celiac disease; 56 were antibody positive and thus invited to clinical evaluation. Eight were diagnosed with biopsy-verified celiac disease. A follow-up questionnaire was sent to antibody-positive individuals 19 months after the clinical evaluation to obtain information on their symptoms and their experience with participation in the screening.

Results Before screening, participants subsequently diagnosed with celiac disease did not differ from the rest of the population with respect to symptoms, but had significantly lower total cholesterol. Tissue transglutaminase IgA antibodies with a cut-off of 10 U/ml had a positive predictive value of 88%. The majority of participants were satisfied with their participation in the screening program. Individuals with celiac disease were generally satisfied with having been diagnosed and 71% felt better on a gluten-free diet.

Conclusion There were no differences in the prevalence of symptoms between participants with and without screening-detected celiac disease, confirming that risk stratification in a general population by symptoms is difficult. The majority of participants diagnosed with celiac disease felt better on a gluten-free diet despite not reporting abdominal symptoms before diagnosis and participants in the clinical evaluation were generally satisfied with participation in the screening program.

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aResearch Centre for Prevention and Health, The Capital Region, Glostrup

bQ&D, Research Unit and Department of Gastroenterology, Herlev and Gentofte Hospital

cDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen

dDepartment of Clinical Experimental Research, Rigshospitalet, Denmark

Correspondence to Line L. Kårhus, MD, Research Centre for Prevention and Health, The Capital Region, Rigshospitalet, Nordre Ringvej 57, Building 84-85, DK-2600 Glostrup, Denmark Tel: +45 38633260; fax: +45 38633977; e-mail:

Received April 22, 2016

Accepted June 17, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.