Belangrijkste concepten
Nationwide screening for celiac disease in Italian children can help uncover undiagnosed cases and provide valuable insights, but challenges remain regarding the long-term benefits and cost-effectiveness of such a program.
Samenvatting
The article discusses the decision by the Italian Parliament to approve national screening for celiac disease in children aged 1-17 years. This follows a screening trial led by Carlo Catassi, a professor of pediatrics, which found a higher-than-expected prevalence of celiac disease in Italian children, with only 40% of cases previously diagnosed.
The debate around celiac disease screening has been ongoing for nearly 30 years. While some argue that screening can lead to false positives and turning healthy individuals into patients, the proponents believe that early diagnosis is crucial to prevent long-term health complications, even in asymptomatic cases.
The article highlights the reliability of the anti-tissue transglutaminase immunoglobulin A (anti-tTG IgA) test as a screening tool, with a sensitivity of 93% and specificity of 98%. However, it also notes that a small percentage of people with celiac disease may have IgA deficiency, leading to false negatives.
The US Preventive Services Task Force has concluded that the evidence is insufficient to assess the balance of harms and benefits of celiac disease screening. Wanda Nicholson, the current chair of the task force, emphasizes the need for more studies comparing the outcomes of screened and unscreened individuals, as well as the impact of gluten-free diets on those who test positive.
Despite some reservations, the article suggests that the Italian program could provide valuable insights that will inform future policy decisions on celiac disease screening in other countries.
Statistieken
Celiac disease affects 1 in 70 people worldwide.
The screening trial in Italy found a prevalence of 1.65% in a sample of almost 4500 children, which is nearly 1 in every 60 children.
Only 40% of children with celiac disease had been diagnosed prior to the trial, indicating that 60% of patients with celiac disease remain undetected in Italy.
Citaten
"Even in a country with a good healthcare system like Italy, a high percentage of cases remain undiagnosed. This was true many years ago and still is true today."
"We didn't have a single case of false positive. If anything, the problem might be with false negatives."
"This is very difficult to demonstrate because you should do a long-term study where you screen people and then treat only 50% of them."