Low Yield for Routine Laboratory Checks in Follow-up of Coeliac Disease
Jordy P.W. Burger1*, Jouke J.H. van der Laan1*, Tom A. Jansen1, Joost P.H. Drenth2, Elisabeth A. Roovers3, Margreet M.S. Wessels4, Peter J. Wahab1
1) Department ofGastroenterology and Hepatology, Rijnstate Hospital, Arnhem,
2) Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen,
3) Clinical Research Department Rijnstate Hospital, Arnhem,
4) Department of Paediatrics, Rijnstate Hospital, Arnhem, The Netherlands
Aim: To evaluate the yield of routine laboratory tests and Dual Energy X-ray Absorptiometry (DEXA) scans in coeliac disease.
Methods: A retrospective analysis of medical files of all followed-up patients with coeliac disease attending Rijnstate Hospital in 2016 was conducted with respect to blood tests of hemoglobin, vitamin B12, folate acid, iron status, calcium, vitamin D, glucose, thyroid function, DEXA-scans and related symptoms or signs of abnormalities. All patients had positive coeliac serology and/or biopsy-proven coeliac disease and attended regular visits after diagnosis. The chi-square test for trend was used for statistical analysis: a two-tailed probability of p < 0.05 was considered significant.
Results: We analyzed 250 patients with a median follow-up of 7.8 (1-22) years. At diagnosis, we found anemia in 24.4%, iron deficiency in 38%, folic acid deficiency in 22.6% and vitamin B12 deficiency in 15.9%. All deficiencies recovered within 1-2 years with or without supplements. Deficiencies or autoimmune diseases occurred in 50 patients (37 possibly coeliac-related) during follow-up. Twelve cases of coeliac-related deficiencies or autoimmune diseases occurred in patients with normal values at diagnosis of whom 10 were asymptomatic (incidence 10/1000 patient years). Osteoporosis and osteopenia were present in 23.3% and 35% at diagnosis. In most patients bone mineral density (BMD) improved or stabilized during follow up (p < 0.05), 8% deteriorated.
Conclusions: The incidence of asymptomatic coeliac-related deficiencies or autoimmune diseases is low in patients with normal values at diagnosis. Therefore, routine laboratory screening is not necessary in this group: attending regular follow-up visits should be sufficient. DEXA scans are recommended.
Key words: Coeliac disease − Gluten-free diet − Autoimmune diseases − DEXA/BMD − Nutritional deficiencies.
Abbreviations: BMD: bone mineral density; DEXA: Dual Energy X-ray Absorptiometry; EMA: endomysial autoantibodies; ESPGHAN: European Society for Paediatric Gastroenterology; HbA1: glycated hemoglobin; MCV: mean corpuscular volume; TSH: thyroid-stimulating hormone.