Study: Less Screening in Down Syndrome?

Screening children with Down syndrome for celiac disease if they have no symptoms does more harm than good, a new study says.

Such routine screening, which is recommended by at least one medical professional organization, is intended to result in early treatment of celiac disease, an inability to tolerate gluten that is thought to increase the risk of intestinal lymphoma.

But treating the disease before symptoms occur does not appear to improve the child’s quality of life, or improve the longterm outcomes of the disease, according to a study by Indiana University School of Medicine researchers. The findings are published in the August issue of Pediatrics.

Using decision analysis, or weighing alternatives in terms of their benefits and liabilities, the researchers looked at the potential benefit of preventing gastrointestinal malignancy by detecting celiac disease in children without symptoms of the disease.

They then weighed the benefit against the cost and quality of life issues associated with screening and treatment of celiac disease.

They also calculated the number of asymptomatic children with Down syndrome who needed to be screened to prevent a single case of lymphoma.

The researchers reported that routine screening of all children with Down syndrome would cost $500,000 per life-year gained and that screening all asymptomatic children with Down syndrome for celiac disease would cost almost $5 million to prevent a single case of lymphoma.

And the financial costs of routine screening for those without symptoms of celiac disease is far from the only issue. Even small decrements in the quality of a child’s life caused by dietary restrictions more than off-set the trivial and unproven reduction in the risk of lymphoma, the authors wrote.