No one likes invasive medical procedures; doctors and researchers are always on the lookout for ways to diagnose celiac disease that avoid intestinal biopsy. This is especially true when it comes to babies and children. A recent study conducted in Spain and published in Revista Espanola De Enfermedades Digestivas evaluated the accuracy of a point-of-care test (POCT) – diagnostic testing at the time and place of patient care – called Simtomax in diagnosing new cases of celiac disease in children. Requiring just a pin-prick sample of blood, Simtomax yields results in just 10 minutes at the point of care.
One hundred children 18 years or younger were recruited to participate in the study. All of the children were experiencing gastrointestinal symptoms for which they were referred to a specialist, and none of the children were already following a gluten-free diet. All of the children were evaluated using ESPGHAN guidelines, the current European standard for diagnosis, and 48 were given a diagnosis of celiac disease. These same patients were also given the POCT, and the results were compared. Overall, the POCT was found to be 100% accurate in children under age 10. Of the 30 children over age 10 who participated in the study, three received different results with the POCT than with standard testing (one false positive, two false negatives). This is still an impressive accuracy rate of 90%.
Current blood testing looks for antibodies (IgA or IgG) to a specific enzyme (tTG) which is known to trigger celiac disease. The presence of above normal numbers of these antibodies indicates that the body is fighting the tTG enzyme and suggests a diagnosis of celiac disease. In babies under two years old, it is more accurate to measure antibodies to a tissue called EmA, which can be found in the umbilical cord. Under ESPGHAN guidelines, children who show elevated IgA through these blood tests are then tested genetically, as only people with a specific gene marker(s) can develop celiac disease. Those who have the necessary gene marker(s) then undergo intestinal biopsy. Under the ESPGHAN guidelines, children with particularly high IgA-tTG levels can be diagnosed without having to do a biopsy.
The POCT test used for this study looks at a slightly different element in the blood. Instead of looking for antibodies to tTG, this test looks for antibodies to deamidated gliadin, one of the main proteins in gluten. These are known to appear in large numbers in patients with celiac disease, and little to not at all in patients without it. The POCT test was performed on the blood sample that had already been drawn from each patient for IgA-tTG testing; no additional procedure was required.
As mentioned above, the POCT test was 100% in agreement with ESPGHAN guideline testing for children under age 10, including one child who was also diagnosed with type 1 diabetes during the test period. These results are encouraging. Contrary to how celiac disease has historically been diagnosed – a days-long process requiring a blood sample from the patient be sent to a laboratory for testing – the minimal invasiveness and quick results of the POCT test could allow for less trauma and earlier intervention for young children. Researchers conclude that this may be the best course for diagnosing celiac disease in the very young.
Click here to read the full study.
 European Society for Paediatric Gastroenterology Hepatology and Nutrition
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