Serological testing for celiac disease unnecessary at follow-up
Complementary serological testing was effective during diagnosis of celiac disease in pediatric patients but lacked relevance during follow-up visits after the introduction of gluten-free interventions, according to recent research.
“Our results indicate that these investigations for iron, folate, and vitamin B12 deficiencies are relevant at the time of diagnosis; up to 28% of the children may have deficiencies at presentation,” Margaretha M.S. Wessels, MD, of the department of pediatrics at Leiden University Medical Center in the Netherlands, and colleagues wrote. “However, ordering these tests at follow-up visits may be questionable because only mild deficiencies occurred in a minority of the children.”
The researchers analyzed blood tests from 182 children evaluated for celiac disease at a pediatric center between 2009 and 2014. They examined deficiencies for abnormal hemoglobin, ferritin, folate, vitamin B12, calcium, vitamin D, free thyroxin and thyroid stimulating hormones.
Data showed that 119 patients received an initial diagnosis of celiac disease, while the remainder were either diagnosed before 2009 or had an initial diagnosis made at another facility. Deficiencies, including those for iron, were identified in up to 28% of children during initial diagnosis; however, only 5% to 10% of children presented with mild deficiencies at follow-up.
The researchers said unnecessary use of serological testing during follow-up add a burden of time consumption and cost expenditure to hospitals.
“As of 2014, this costs approximately €150 to €200 per patient, merely for extracting and handling blood samples in our laboratory, and exclusive of celiac serology charges,” Wessels and colleagues wrote. “We recommend that these variables only be assessed on indication, such as fatigue or abnormal growth.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.