Clinical, Serologic, and Histologic Characteristics in Screen-Detected and Clinically Diagnosed Celiac Disease Patients

Abstract

Background and Aims: The benefits of celiac disease screening remain debatable. We compared baseline characteristics and treatment outcomes between screen-detected and clinically diagnosed celiac disease adults in a prospective study. Methods: Clinical, serologic, and histologic data and bone mineral density (BMD) were assessed in 214 patients at diagnosis and after 1 year on gluten-free diet (GFD). Validated questionnaires were used to elicit gastrointestinal symptoms (Gastrointestinal Symptoms Rating Scale) and quality of life (Psychological General Well-Being questionnaire). Results: Screen-detected patients (n = 102) were older (median, 54 vs 43 years; P = .005), more often men (50% vs 16%; P < .001), and had higher mean lumbar T-score (−0.8 vs −1.2 standard deviation; P = .011) and hemoglobin levels (140 vs 128 g/dL; P < .001) at diagnosis than clinically diagnosed patients (n = 112). The groups were comparable in transglutaminase 2 (24.5 vs 47.7 U/mL; P = .051) and endomysial (1:200 vs 1:200; P = .385) autoantibody levels and histology assessed by villous height/crypt depth ratio (0.3 vs 0.3; P = .964). Screen-detected patients had fewer gastrointestinal symptoms (Gastrointestinal Symptoms Rating Scale total score 1.9 vs 2.6; P < .001) and better quality of life (Psychological General Well-Being questionnaire total score 107 vs 98; P = .001). After 1 year, both groups showed similar GFD adherence (94% vs 95%; P = .000) and improvements in histology, BMD, and quality of life. Asymptomatic and symptomatic screen-detected patients were comparable in histologic findings at diagnosis, adherence to GFD, and improvements in symptoms and quality of life. Conclusion: Screen-detected celiac disease patients demonstrated less severe symptoms and BMD impairment at diagnosis but advanced histologic and serologic disease similar to those identified on clinical grounds. Adherence to GFD and treatment response were comparable between the groups.