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      Long-term health and treatment outcomes in adult coeliac disease patients diagnosed by screening in childhood

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          Abstract

          <div class="section"> <a class="named-anchor" id="d8570478e188"> <!-- named anchor --> </a> <h5 class="section-title" id="d8570478e189">Background</h5> <p id="d8570478e191">The diagnostic yield of coeliac disease could be improved by screening in at-risk groups, but long-term benefits of this approach are obscure. </p> </div><div class="section"> <a class="named-anchor" id="d8570478e193"> <!-- named anchor --> </a> <h5 class="section-title" id="d8570478e194">Objective</h5> <p id="d8570478e196">To investigate health, quality of life and dietary adherence in adult coeliac patients diagnosed in childhood by screening. </p> </div><div class="section"> <a class="named-anchor" id="d8570478e198"> <!-- named anchor --> </a> <h5 class="section-title" id="d8570478e199">Methods</h5> <p id="d8570478e201">After thorough evaluation of medical history, follow-up questionnaires were sent to 559 adults with a childhood coeliac disease diagnosis. The results were compared between screen-detected and clinically-detected patients, and also between originally asymptomatic and symptomatic screen-detected patients. </p> </div><div class="section"> <a class="named-anchor" id="d8570478e203"> <!-- named anchor --> </a> <h5 class="section-title" id="d8570478e204">Results</h5> <p id="d8570478e206">In total, 236 (42%) patients completed the questionnaires a median of 18.5 years after childhood diagnosis. Screen-detected patients ( <i>n</i> = 48) had coeliac disease in the family and type 1 diabetes more often, and were less often smokers and members of coeliac societies compared to clinically-detected patients, whereas the groups did not differ in current self-experienced health or health concerns, quality of life or dietary adherence. Screen-detected, originally asymptomatic patients had more anxiety than those presenting with symptoms, whereas the subgroups were comparable in other current characteristics. </p> </div><div class="section"> <a class="named-anchor" id="d8570478e211"> <!-- named anchor --> </a> <h5 class="section-title" id="d8570478e212">Conclusion</h5> <p id="d8570478e214">Comparable long-term outcomes between screen-detected and clinically-detected patients support risk-group screening for coeliac disease. However, asymptomatic patients may require special attention. </p> </div>

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          Most cited references 27

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          Celiac disease revealed in 3% of Swedish 12-year-olds born during an epidemic.

          Sweden experienced a marked epidemic of celiac disease between 1984 and 1996 in children younger than 2 years of age, partly explained by changes in infant feeding. The objective of this study was to determine the prevalence of celiac disease in 12-year-olds born during the epidemic (1993), including both symptomatic and screening detected cases. All sixth-grade children in participating schools were invited (n = 10,041). Symptomatic and, therefore, previously diagnosed celiac disease cases were ascertained through the National Swedish Childhood Celiac Disease Register and/or medical records. All serum samples were analyzed for antihuman tissue transglutaminase (tTG)-IgA (Celikey), and serum-IgA, and some for tTG-IgG and endomysial antibodies. A small intestinal biopsy was recommended for all children with suspected undiagnosed celiac disease. Participation was accepted by 7567 families (75%). Previously diagnosed celiac disease was found in 67 children; 8.9/1000 (95% confidence interval [CI] 6.7-11). In another 192 children, a small intestinal biopsy was recommended and was performed in 180. Celiac disease was verified in 145 children, 20/1000 (95% CI 17-23). The total prevalence was 29/1000 (95% CI 25-33). The celiac disease prevalence of 29/1000 (3%)-with two thirds of cases undiagnosed before screening-is 3-fold higher than the usually suggested prevalence of 1%. When these 12-year-olds were infants, the prevailing feeding practice was to introduce gluten abruptly, often without ongoing breast-feeding, which might have contributed to this unexpectedly high prevalence.
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            Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease

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              The US Preventive Services Task Force 2017 Draft Recommendation Statement on Screening for Prostate Cancer

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                Author and article information

                Journal
                United European Gastroenterology Journal
                United European Gastroenterology Journal
                SAGE Publications
                2050-6406
                2050-6414
                April 13 2018
                August 2018
                May 17 2018
                August 2018
                : 6
                : 7
                : 1022-1031
                Affiliations
                [1 ]Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
                [2 ]Department of Pediatrics, Hospital District of South Ostrobothnia, Seinäjoki, Finland
                [3 ]Institute for Mother and Child Health Bucharest, University of Medicine and Pharmacy ‘Carol Davila’, Bucharest, Romania
                [4 ]Department of Pediatrics, Hospital District of Kanta-Häme, Hämeenlinna, Finland
                [5 ]Faculty of Social Sciences, University of Tampere, Tampere, Finland
                [6 ]Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
                [7 ]Celiac Disease Research Center, University of Tampere, Tampere, Finland
                Article
                10.1177/2050640618778386
                6137595
                30228890
                © 2018

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