INCIDENCE OF CELIAC DISEASE IN NORTH AMERICAN CHILDREN WITH RECURRENT ABDOMINAL PAIN

Abstract

The incidence of celiac disease in North America is thought to be much lower than Europe. Recently, questions have been raised, primarily in Europe, regarding the possibility that North American pediatric gastroenterologists have not been sufficiently aggressive in pursuing evaluation of potential celiacs. The recent discovery of a high incidence of positive endomysial antibodies in North American blood donors supports this hypothesis. In order to further test this hypothesis, we measured endomysial antibodies in 108 children evaluated in our pediatric gastroenterology clinic for recurrent abdominal pain. None had diarrhea, and it would not have previously occurred to us to screen these children for celiac disease. Two of the 108 children had positive endomysial antibodies. Both were found to have flat small bowel biopsies and their abdominal pain resolved following institution of a gluten free diet. Neither had diarrhea or physical findings suggestive of celiac disease. Both were postpubertal adolescent girls. An incidence of nearly 2% is much higher than we would have predicted in this population. These findings suggest that celiac disease may be more common in North America than previously thought. If further studies confirm these observations, more aggressive pursuit of the diagnosis of celiac disease by North American pediatric gastroenterologists appears warranted.