Screening for celiac in children in Italy – a new scientific article alters the current national guidelines!

What is celiac?

We have a mythological chapter on this website about celiac, written by one of the world’s renowned celiac experts, Professor Raanan Shamir, in the following link.

In short, it is a chronic disease that belongs to the group of autoimmune illnesses (diseases in which the body attacks its own self) and it is caused the exposure of the body to gluten combined with genetic and environmental factors.

Introduction to the article – this is a disease that is found in about 1% of the population in different countries. Diagnosing the condition is quite difficult, as some people present with straight-forward symptoms while others don’t.

In addition, it is well known that celiac is more common in people who have a specific HLA antigen, such that if we were all aware of the type of HLA antigen our children carry, we would maybe be able to perform a blood test to test for celiac on those who carry a specific antigen.

So, how is screening for celiac carried out nowadays?

Screening for celiac is not done on everyone, rather on specific populations of people who are at high risk of developing the condition – those who have a family history of celiac, children with specific signs and symptoms, etc. When celiac is suspected, we start by drawing blood to test for antibodies for celiac disease.

However, the question of the real prevalence of the disease remains, and whether this prevalence justifies moving to a more universal screening method to check all children, so that we can also detect those who present with non-specific symptoms or no symptoms at all.

Methods – children ages 5-12 years from 6 different cities in Italy, representing the entire country, underwent screening for two specific types of HLA (DQ2/DQ4 for our advanced readers) by sampling capillary blood (capillary blood is taken from the tip of the fingers, and does not require a full blood draw from a vein in the area of the elbow). Those who were found to be positive for the two types of HLA underwent a “regular” blood test for celiac and afterwards, some of whom were found positive in the blood test, underwent a biopsy of the upper gastrointestinal tract as commonly accepted in the diagnosis of celiac.

Of course, children with known celiac disease, or children who do not eat gluten, were not included in the study.

Results – almost 4500 children were screened, while 1872 children were found to have an HLA that was potentially suitable for celiac and most of these 1872 continued to the next screening part of the study.

In practice, about 48 children (1.15%) were found to have celiac, and half did not have any leading symptoms while the other half had very non-specific symptoms such as recurrent abdominal pain, constipation, etc.

Now, if we take into account the children who did not undergo screening because they were already diagnosed with celiac, then the prevalence of celiac in the Italian population comes up to 1.65%!

Another way to analyze the statistics is to say that about 40% of children were diagnosed prior to the study and 60% were diagnosed because of the study!

Because the authors had published two previous studies about celiac, we are able to see a rise in the number of people with celiac within the past 20 years, mainly because of the increase in awareness and the tests that are being done. However, all in all, the prevalence of the disease did not increase significantly from one study to the next.

Discussion – should we be screening all children for celiac?

Before we attempt to answer this question, it is important to understand the following points:

The prevalence of celiac varies from one country to another, and also from one region to another. In China, for example, the prevalence is much lower than it is in Sweden, and so forth. So, the answer to this question depends on the country and the prevalence.
It is worthwhile noting that this study practiced a novel screening method – capillary blood, which is easier to draw, was first sampled, and venous blood was only drawn from those with a specific HLA. So, the screening was done in two different stages, in a very elegant and efficient way, given that the method is verified and does not miss anyone with the condition. Note that in other parts of the world, usually antibodies are first tested.
In this study, when comparing it to previous studies carried out in the same place, there was a rise in the number of people with celiac disease, already before the study was completed. Great. And yet, about 60% of the cases were discovered only after the study. That means that for every 1 person with celiac that you know, there is probably another one, it’s just that they haven’t been tested and they don’t know.
Does having celiac disease and not knowing about it mean anything? Well, the Italian parliament was convinced by this study and starting January 2024, all the children in Italy are screened for celiac.

Regardless of what your country’s guidelines are, I urge you to ask your family doctor to test your child for celiac if they are over two years old. Whether they are experiencing symptoms, or not. In certain situations, I also recommend repeating the test once, at an older age.

And of-course this test is crucial if your child is experiencing leading symptoms, such as short stature or iron deficiency.

Or in other words, until there is universal screening of celiac for all children, everywhere, I suggest you make sure your own children are tested yourself.

What are the signs and symptoms of celiac disease? Find out in this post.

Good luck!