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©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Mar 21, 2009; 15(11): 1331-1338
Published online Mar 21, 2009. doi: 10.3748/wjg.15.1331
Impact of mass screening for gluten-sensitive enteropathy in working population
Meritxell Mariné, Fernando Fernández-Bañares, Montserrat Alsina, Carme Farré, Montserrat Cortijo, Rebeca Santaolalla, Antonio Salas, Margarita Tomàs, Elias Abugattas, Carme Loras, Ingrid Ordás, Josep M Viver, Maria Esteve
Meritxell Mariné, Fernando Fernández-Bañares, Rebeca Santaolalla, Carme Loras, Ingrid Ordás, Josep M Viver, Maria Esteve, Department of Gastroenterology, University Hospital of Mútua de Terrassa, Research Foundation Mútua de Terrassa, University of Barcelona, 08221 Terrassa, Catalonia, Spain
Antonio Salas, Department of Pathology, University Hospital of Mútua de Terrassa, Research Foundation Mútua de Terrassa, University of Barcelona, 08221 Terrassa, Catalonia, Spain
Montserrat Alsina, Department of Immunology (Catlab), University Hospital of Mútua de Terrassa, Research Foundation Mútua de Terrassa, University of Barcelona, 08221 Terrassa, Catalonia, Spain
Carme Farré, Department of Biochemistry, Sant Joan de Déu Hospital, Esplugues, 08950 Catalonia, Spain
Montserrat Cortijo, Margarita Tomàs, Elias Abugattas, Occupational Health Department, Egarsat (Prevention Society), Sant Cugat del Vallès, 08173 Catalonia, Spain
Author contributions: Mariné M, Esteve M, Fernández-Bañares F, Salas A and Viver JM contributed to the study concept and design. Mariné M, Esteve M, Santaolalla R, Fernández-Bañares F, Alsina M, Farré C, Salas A, Tomàs M, Abugattas E, Ordás I, Loras C, Cortijo M and Viver JM contributed to the acquisition of data; Salas A performed the histopathological analysis; Methodology design and laboratory analysis was carried out by Mariné M, Esteve M, Fernández-Bañares F, Santaolalla R, Alsina M, Farré C; Mariné M, Esteve M, Fernández-Bañares F, Salas A, Alsina M performed the analysis and interpretation of data; Mariné M, Esteve M, Fernández-Bañares F, Viver JM wrote the manuuscript; Mariné M, Esteve M, Fernández-Bañares F, Alsina M, Farré C, Cortijo M, Santaolalla R, Salas A, Tomàs M, Abugattas E, Loras C, Ordás I, Viver JM carried out a critical revision of the manuscript for important intellectual content; Esteve M, Mariné M, Fernández-Bañares F performed the statistical analysis; The study was supervised by Esteve M, Fernández-Bañares F, Mariné M.
Correspondence to: Maria Esteve, MD, Department of Gastroenterology, University Hospital of Mútua de Terrassa, University of Barcelona, Plaça Dr Robert nº 5, 08221 Terrassa, Barcelona, Catalonia, Spain.
mestevecomas@telefonica.net
Telephone: +34-93-7365050
Fax: + 34-93-7365043
Received: December 19, 2008
Revised: February 12, 2009
Accepted: February 19, 2009
Published online: March 21, 2009
AIM: To assess: (1) frequency and clinical relevance of gluten sensitive enteropathy (GSE) detected by serology in a mass screening program; (2) sensitivity of antitransglutaminase (tTGA) and antiendomysium antibodies (EmA); and (3) adherence to gluten-free diet (GFD) and follow-up.
METHODS: One thousand, eight hundred and sixty-eight subjects recruited from an occupational health department underwent analysis for tTGA and EmA and, if positive, duodenal biopsy, DQ2/DQ8 genotyping, clinical feature recording, blood tests, and densitometry were performed. Since > 98% of individuals had tTGA < 2 U/mL, this value was established as the cut-off limit of normality and was considered positive when confirmed twice in the same sample. Adherence to a GFD and follow up were registered.
RESULTS: Twenty-six (1.39%) subjects had positive tTGA and/or EmA, and 21 underwent biopsy: six Marsh III (one IIIa, four IIIb, one IIIc), nine Marsh I and six Marsh 0 (frequency of GSE 1:125). The sensitivity of EmA for GSE was 46.6% (11.1% for Marsh I, 100% for Marsh III), while for tTGA, it was 93.3% (88.8% for Marsh I, 100% for Marsh III). All 15 patients with abnormal histology had clinical features related to GSE. Marsh I and III subjects had more abdominal pain than Marsh 0 (P = 0.029), and a similar trend was observed for distension and diarrhea. No differences in the percentage of osteopenia were found between Marsh I and III (P = 0.608). Adherence to follow-up was 69.2%. Of 15 GSE patients, 66.7% followed a GFD with 80% responding to it.
CONCLUSION: GSE in the general population is frequent and clinically relevant, irrespective of histological severity. tTGA is the marker of choice. Mass screening programs are useful in identifying patients who can benefit from GFD and follow-up.
