Screening of celiac disease in Down syndrome - Old and new dilemmas

Table 1 Health care guidelines for people with Down syndrome

Association	Screening for other diseases	CD screening	CD antibodies	Further CD antibodies testing	HLA testing
United Kingdom Down’s Syndrome Medical Interest Group[41]	Thyroid function	No	No	No	No
American Academy of Pediatrics[42]	Thyroid function, anemia	Symptomatic patients	IgA, IgA anti-TG2	No	No
American Family Physician[43]	Thyroid function, diabetes mellitus	Not for adult	No	No	No
American Gastroenterological Association[44]		Symptomatic patients	IgA anti-TG2, IgA EMA	No	If other tests is not clear
National Institute for Health and Care Excellence[45]		In all patients	IgA anti-TG2	No	No
European Down Syndrome Association[46]	Thyroid function, anemia, immunological defects	In all patients	IgG, IgA AGA, IgA anti-TG2, IgA EMA	Annually	No
Down’s Syndrome Medical Interest Group[47]	Thyroid function	At 2-3 yr in all patients	IgA EMA	No	No
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition[48]		After 3 yr in all patients	IgA, IgA anti-TG2	Some years	If IgA anti-TG2 negative
European Society for Pediatric Gastroenterology, Hepatology and Nutrition[15]		After 2 yr in all patients	IgA anti-TG2 if HLA positive	Every 2 to 3 yr in DQ2 or DQ8 positive children	Yes

CD: Celiac disease; EMA: Antiendomisium antibodies; AGA: Antigliadin antibodies; anti-TG2: Tissue transglutaminase antibodies; IgA: Immunoglobulin A; IgG: Immunoglobulin G.