Mass Screening for Celiac Disease: The Autoimmunity Screening for Kids Study

Am J Gastroenterol. 2021 Jan 1;116(1):180-187. doi: 10.14309/ajg.0000000000000751.

Marisa G Stahl 1, Cristy Geno Rasmussen 2, Fran Dong 2, Kathleen Waugh 2, Jill M Norris 3, Judith Baxter 2, Liping Yu 2, Andrea K Steck 2, Brigitte I Frohnert 2, Edwin Liu 1, Marian J Rewers 2, ASK Study Group


Author information

  • 1Department of Pediatrics, Digestive Health Institute, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
  • 2Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
  • 3Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.


Introduction: The Autoimmunity Screening for Kids (ASK) study is a large scale pediatric screening study in Colorado for celiac disease (CD) and type 1 diabetes. This is a report of the CD outcomes for the first 9,973 children screened through ASK.

Methods: ASK screens children aged 1-17 years for CD using 2 highly sensitive assays for tissue transglutaminase autoantibodies (TGA): a radiobinding (RBA) assay for IgA TGA and an electrochemiluminescence (ECL) assay that detects all TGA isotypes. Children who test positive on either assay are asked to return for confirmatory testing. Those with a confirmed RBA TGA level ≥ 0.1 (twice the upper limit of normal) are referred to the Colorado Center for Celiac Disease for further evaluation; all others are referred to primary care.

Results: Of the initial 9,973 children screened, 242 children were TGA+ by any assay. Of those initially positive, 185 children (76.4%) have completed a confirmation blood draw with 149 children (80.5%) confirming positive by RBA TGA. Confirmed RBA TGA+ was associated with a family history of CD (odds ratio [OR] = 1.83; 95% confidence interval 1.06-3.16), non-Hispanic white ethnicity (OR = 3.34; 2.32-4.79), and female sex (OR = 1.43; 1.03-1.98). Gastrointestinal symptoms of CD, assessed at the initial screening, were reported equally often among the RBA TGA+ vs TGA- children (32.1% vs 30.5%, P = 0.65).

Discussion: The initial results of this ongoing mass-screening program confirm a high prevalence of undiagnosed CD autoimmunity in a screened US population. Symptoms at initial screening were not associated with TGA status (see Visual abstract, Supplementary Digital Content 5, http://links.lww.com/AJG/B587).

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