Mass Screening for Celiac Disease Among School‐aged Children

Abstract

ABSTRACTObjectives:We conducted this mass screening study to determine the prevalence of celiac disease (CD) and characterize the celiac iceberg among Saudi pediatric population in Riyadh, the capital city of Saudi Arabia.Methods:During the study period (January 2014–June 2016), we have conducted a cross‐sectional, mass screening, immunoglobulin A‐tissue transglutaminase (TTG‐IgA)‐based study on 7930 Saudi students from primary and intermediate schools in Riyadh. Students with positive TTG‐IgA (>20 U/L) were called in the hospital to undergo a repeat of TTG‐IgA; in those with borderline positive TTG‐IgA (20–60 U/L), IgA‐endomyseal antibody (EMA‐IgA) test was performed. Children with TTG‐IgA >60 U/L and children with borderline positive TTG‐IgA and positive EMA‐IgA were advised to undergo upper endoscopy and intestinal biopsies.Results:We identified 221 students with positive TTG‐IgA (2.8%). CD was diagnosed in 119 cases (1.5%, 1:67 Saudi children) (mean age 11.5 ± 2.62 years; girls 81 [68%]). Another 51 children had persistently borderline positive TTG‐IgA but negative EMA (0.64%) and the remaining 51 had transiently positive TTG‐IgA. We have identified 3 clinical patterns in the screening‐identified cases with CD: a silent form (37%), a mild symptomatic form characterized by gastrointestinal symptoms in presence of normal growth or overweight/obesity (48%), and gastrointestinal symptoms associated with impaired growth in 15%.Conclusions:Our study provided evidence of a high prevalence of CD among Saudi children (1.5%), a rate that is at least twice the average prevalence rate in Europe and North America.