UEG Journal Abstracts 2022 - 32

Update in coeliac disease
16:30-17:30 / Lehar 3
OP033
THE EFFECT OF A GLUTEN FREE DIET ON FATIGUE IN CELIAC
DISEASE - A PROSPECTIVE CONTROLLED STUDY
OP032
EARLY DIAGNOSIS OF COELIAC DISEASE BY CASE-FINDING AT THE
PREVENTIVE YOUTH HEALTH CARE CENTRES IN THE NETHERLANDS
(GLUTENSCREEN)
C. Meijer-Boekel1
, L. Smit2, F. van Overveld3
Kennemerland, Netherlands, 3
Naarden, Netherlands, 4
Netherlands
Contact E-Mail Address: c.r.meijer-boekel@lumc.nl
Introduction: Objectives: Coeliac disease (CD) occurs in 1% of the population,
but is severely underdiagnosed. Secondary prevention by early diagnosis
may be achieved by case-finding.
Aims & Methods: To prospectively assess whether case-finding at the Preventive
Youth Health Care Centres (YHCCs) in the Netherlands is a feasible
and effective strategy for early CD-diagnosis.
We analyzed data from the case-finding study GLUTENSCREEN from
its start at 4th
February 2019 till 4th
January 2022 (with interruption of 5
months due to COVID19). Parents of all symptomatic children aged 1-4
years attending the YHCC in the Kennemerland-region for a regular visit,
were asked if their child has ≥1 CD-related symptoms. If so, a point-of-caretest
(POCT) to assess CD-specific antibodies against tissue transglutaminase
(TGA), was performed onsite the YHCCs. If the POCT was positive, the
child was referred to our hospital for definitive diagnosis according to the
ESPGHAN guideline.
Results: 36.9% (5706/15466) of the children had ≥1 CD-related symptoms.
Parents of 3104 (54.4%) children gave informed consent for a POCT (47%
female; median age 2.8years). In 61 children the POCT was positive: CD
was confirmed in 55 children (2.0% of the tested children) and ruled out in
5 children. Of them two children had negative HLA-DQ2/8 and TGA (ELISAtest)
and in 3 children with TGA <10xULN small bowel biopsies showed
Marsh 0-1 lesions. From one child who was referred to the hospital, parents
refused additional investigation.
Conclusion: Case-finding for CD using a POCT is effective and feasible
and it detects a high CD prevalence of 1.8%. Before implementation of
the case-finding strategy cost-effectiveness and acceptability analyses are
needed.
Disclosure: No conflict of interest.
, M.L. Mearin4
1Leiden University Medical Center, Peadiatric Gastroenterology,
Leiden, Netherlands, 2
Preventive Youth Health Care Centres,
Dutch Coeliac Patients Society,
Leiden University Medical Centre, Leiden,
B.M. Skjellerudsveen1
L. Aabakken5
1
, R. Omdal1,2
, I.M. Skoie6
, A.K. Hetta1, J.T. Kvaløy3,4
, T. Grimstad1,2
Stavanger University Hospital, Department of Internal
Medicine, Stavanger, Norway, 2
of Clinical Science, Bergen, Norway, 3
University of Bergen, Department
University of Stavanger,
Department of Mathematics and Physics, Stavanger, Norway,
4
Stavanger University Hospital, Department of Research,
Stavanger, Norway, 5Rikshospitalet-Radiumhospitalet HF,
Dept. Of Medical Gastroenterology, Oslo, Norway, 6
Stavanger
University Hospital, Department of Dermatology, Stavanger,
Norway
Contact E-Mail Address: berit.mere.skjellerudsveen@sus.no
Introduction: Fatigue, often defined as " an overwhelming sense of tiredness,
lack of energy and feeling of exhaustion " [1] is a frequent complaint
in patients with various chronic inflammatory and autoimmune diseases,
and appears to be a major problem also in celiac disease. A strict gluten
free diet is the only established treatment for patients with celiac disease,
but how this diet influences fatigue is largely unknown.
Aims & Methods: Objective: To investigate the course of fatigue, its prevalence
and severity, in celiac disease patients from time of diagnosis to one
year after commencing a gluten free diet. To investigate whether certain
clinical findings and selected biochemical markers were associated with
fatigue.
Methods: Single-center prospective controlled study of 78 patients with
newly diagnosed celiac disease, compared with 78 age- and sex-matched
healthy subjects.
The primary endpoints were fatigue severity as measured by the fatigue
Visual Analog Scale (fVAS) [2], the Fatigue Severity Scale (FSS) [3], and the
inverted Vitality subscale of the Medical Outcomes Study 36-Item ShortForm
Health Survey (SF-36vs) [4]. Clinically relevant fatigue was defined
by a FSS score of ≥4, a fVAS score of ≥50 mm and an inverted SF-36vs score
of ≥65. Study visits were performed at time of diagnosis and after adhering
to a gluten free diet for one year.
Secondary endpoints were the associations between fatigue and sex, age,
depression, pain, concurrent autoimmune disease, histology and selected
biochemical variables including anti-tissue transglutaminase-IgA antibodies,
deamidated gliadin peptide IgG-antibodies, cobalamin, ferritin,
folic acid, hemoglobin, and vitamin D.
Results: Fatigue severity was significantly reduced after 12 months of gluten
free diet for all three instruments (Table 1). Higher scores represent
more fatigue. Fatigue prevalences decreased from 42-54% in celiac patients
at diagnosis to 18-22% after one year of gluten free diet, compared
with 0-3% in healthy control subjects.
Patients
V0
fVAS
FSS
Inverted
SF-36vs
44.5
(18.8-66.0)
3.8
(2.2-4.8)
65
(40-75)
Patients
V12
15.5
(7.8-43.3)
1.9
(1.4-3.5)
35
(25-55)
p-value V0V12
p<0.001
p<0.001
p<0.001
HCS
8.0
(2.0-16.0)
1.4
(1.0-2.0)
30
(20-40)
p-value
V12-HCS
p<0.001
p<0.001
p=0.003
Data
are presented as median (interquartile range)
Table 1: Fatigue scores in patients with newly diagnosed celiac disease
(V0), in patients after one year of gluten free diet (V12) and in healthy
control subjects (HCS).
32
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