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What Other Screening Tests Should be Administered to Celiac Disease Patients?

What Other Screening Tests Should be Administered to Celiac Disease Patients? 1024 575 Mary Bates, PhD

Eliminating some labs may reduce costs without impacting quality of patient care.

Researchers from Nationwide Children’s Hospital found that several screening laboratory tests currently recommended for pediatric patients newly diagnosed with celiac disease are infrequently abnormal. In a new study published in the Journal of Pediatrics, they suggest a more streamlined approach to decrease the burden of testing on patients and reduce health care expenditures.

In celiac disease, the ingestion of gluten triggers an autoimmune response, leading to inflammation and damage to the small intestine, as well as non-gastrointestinal symptoms. Other recommended laboratory tests at the time of diagnosis include a complete blood count, ferritin, iron, total iron-binding capacity, 25-hydroxy vitamin D, thyroid-stimulating hormone (TSH), alanine aminotransferase and aspartate aminotransferase, and screening for hepatitis B immunization status.

Approximately four years ago, Nationwide Children’s implemented a Celiac Care Index as part of a quality improvement initiative to adhere to published screening recommendations. For the new study, researchers reviewed the charts of over 450 patients enrolled in their celiac disease registry between 2018 and 2022. They analyzed rates of abnormal laboratory values and estimated costs associated with these screening measures.

“We found that a number of these tests are rarely abnormal and could be eliminated without jeopardizing patient care,” says Tracy Ediger, MD, PhD, an attending pediatric gastroenterologist at Nationwide Children’s and senior author of the study.

For example, Dr. Ediger and colleagues suggest that iron deficiency screening may be condensed into just hemoglobin and ferritin testing, with subsequent iron studies administered only as needed. Thyroid screening was also infrequently abnormal, so the team recommends eliminating free T4 testing and using TSH alone to screen. Additionally, the researchers say the usefulness of screening for hepatitis B at the time of celiac diagnosis is uncertain. Based on their data and emerging evidence that hepatitis B vaccine response and immunity is similar in individuals with and without celiac disease, the researchers suggest removing hepatitis B immunity tests from initial screening unless individuals possess specific risk factors.

Some laboratory screening tests appear to be warranted in this population. Dr. Ediger and colleagues conclude that current screening recommendations for aminotransferases and 25-OH vitamin D are useful, though further research is needed to determine the cost-effectiveness of these laboratory tests.

Overall, the research team found that the standard panel of screening laboratory tests for patients with celiac disease costs approximately $1,221 per patient. “With all the changes in labs that we are recommending, we are able to decrease the patient expense by 19% per patient, or about $227,” says Dr. Ediger, who is also an assistant professor of clinical pediatrics at The Ohio State University College of Medicine.

“I think this shows how following through with quality improvement projects can really improve outcomes for patients,” says Dr. Ediger. “We are changing the screening tests we give to patients with celiac disease and as we put these findings out there, hopefully other centers around the country will also think about what tests are really necessary.”

 

Reference:

Farmer PF, Boyle B, Hill I, Kiel A, Ediger T. Single-Center Analysis of Essential Laboratory Testing in Patients with Newly Diagnosed Celiac Disease. J Pediatr. 2023 Aug;259:113487. doi: 10.1016/j.jpeds.2023.113487. Epub 2023 May 16.

About the author

Mary a freelance science writer and blogger based in Boston. Her favorite topics include biology, psychology, neuroscience, ecology, and animal behavior. She has a BA in Biology-Psychology with a minor in English from Skidmore College in Saratoga Springs, NY, and a PhD from Brown University, where she researched bat echolocation and bullfrog chorusing.

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