..... ;i!i~!!i? ~ pliance with gluten-flee diet in adolescents with ' !iiiiscreenm -detected celiac disease: A 5-year follow-up '~:i!! ![i ........ g Elisabetta Fabiani, MD, Luciana Maria Taccar~ MD, Ilse-Maria Rdtsch, MD, Silvia Di Giuseppe, PhD, Giovanni Valentino Coppa, MD, and Carlo Catass4 MD After 5 years of treatment, 22 patients with celiac disease, diagnosed by means of serologic mass screening (mean age, 17.9 years), showed a lower compliance with a gluten-free diet and frequent positivity of serum anti-en- domysium antibodies (32%) in comparison with a group of 22 age-matched patients diagnosed because of "typical" symptoms during childhood. (J Pe- diatr 2000; 136:841-3) Patients affected with celiac disease do not always comply with the gluten-free diet, especially during adolescence. ] The percentage of patients with CD who do not strictly adhere to the GFD ranges from 7% to 55%2; this variabili- ty is related to factors such as age at di- agnosis, sex, school grade, self-esteem, family social class, and education level. 1,3,4No data are available regard- ing long-term compliance with the GFD in patients diagnosed in a mass screening program. This is an impor- tant piece of information when evaluat- ing the cost-effectiveness ratio of the screening. We previously performed serologic screening for CD in 5280 teenagers, which led to the identifica- tion of 28 patients affected with "silent" From the Department of Paediatrics, Urffversity of Ancona, Ancona, Italy. Submitted for publication July 28, 1999; revision receivedNov 12, 1999; acceptedDec 28, 1999. Reprint requests: Carlo Catassi, MD, Uni- versity Department of Paediatrics, Via F Cor- ridoni 11, 60123 Ancona, Italy. Copyright © 2000 by Mosby, Inc. 0022-3476/2000/$12.00 + 0 9/22/105351 doi:10.1067/mpd.2000.105351 or "atypical" CD. 5 The aim of this study was to evaluate the compliance with the GFD in these patients with screening- detected CD after 5 years from the diagnosis in comparison with an age- matched group of patients diagnosed because of typical symptoms of CD. PATIENTS AND METHODS During the period from June to Octo- ber 1998, 2 groups of patients with CD were recalled for evaluation: (1) subjects aged 11 to 14 years who were diagnosed in a mass serologic screening program carried out in central Italy from 1992 to 1994 (group A) and (2) patients with CD diagnosed in our department in 1985 and 1986 because of typical symp- toms such as poor growth, chronic diar- rhea, and anemia (group B). All patients received a biopsy-proven diagnosis of CD in our department, according to the criteria of the European Society of Pae- diatric Gastroenterology and Nutrition. 6 All were advised to start a strict GFD and to return for yearly follow-up visits in our clinic. Each patient underwent the follow- ing investigations: (1) clinical and an- thropometric assessment, (2) dietary interview (food frequency question- naire) conducted by a dietitian, (3) psychologic testing with the self-evalu- ation questionnaires for anxiety (Insti- tute for Personality and Ability Test- ing, Anxiety Questionnaire) and depression (Institute for Personality and Ability Testing, Clinical Depres- sion Questionnaire)/and (4) routine hematologic tests and serologic tests for CD markers (IgA- and IgG-anti- gliadin antibody and IgA-anti-en- domysium antibody), IgA-AGA and IgG-AGA were mea- sured by an enzyme-linked immunosor- bent assay (Alfa-gliatest; Eurospital, Trieste, Italy); IgA-AEA was detected by indirect immunofluorescence, with the distal portion of monkey esophagus as the antigenic substrate (Endomisio, Eurospital), The results were compared by the Mann-Whitney test. RESULTS Of the 27 subjects in group A, 22 agreed to participate in this study. Rea- sons for dropout were change of resi- dence (2 patients) and refusal to par- ticipate (3 patients who were said to be healthy on a normal diet). Of the 24 841