Abstract
BackgroundPrevalence of celiac disease in developed countries is assessed about 1:100–1:150. The real prevalence is unknown because mass screenings are expensive and difficult to organize. Moreover celiac disease can affect people at every age and studies on asymptomatic subjects at different ages are not comparable. In this study we wanted to know the real prevalence of celiac disease in children in the Republic of San Marino. We also analysed concordance of different tests used and costs of mass screening.MethodsThe study started in 1993. From 1993 to 1997 children aged 6, 10 and 14 were screened. Since 1997 only children aged 6 were monitored, in order to have a homogeneous population. In fact, every child born since 1980 was taken into account. Children were recruited by classroom lists of students for general paediatric examination. Until 2005 the screening test was based on dosage of antibodies anti-gliadin (AGA) IgA and IgG on venous blood. Since 2006 these tests were replaced by anti-transglutaminase IgA antibodies (ATTG). Anti-endomysial antibodies (EMA) were performed if result of any between either AGA or ATTG tests was positive or borderline; if EMA was positive, then an endoscopy with histological examination was performed to confirm the final diagnosis.ResultsAttendance to paediatric examination was 96%, submission to blood test was 87%. 42 on 5092 (0,8%; 1:125) children resulted affected by celiac disease. Histology always confirmed diagnosis by serology except for two cases. AGA test (until 2005) yielded 28 on 4304 (0,7% 1:143); ATTG test (since 2006) revealed 14 positive cases on 788 (1,8%; 1:55) leading to a larger percentage of diagnosis. EMA antibodies always confirmed positivity of ATTG.ConclusionsPrevalence of celiac disease in children of Republic of San Marino is comparable to other North-European Countries. Sensitivity of ATTG proved much higher than that of anti-gliadin antibodies. Concordance between ATTG and EMA was 100%. Concordance between serology and histology was approximately 100%. Cost of screening was yearly about 5000 euros (250 children screened every year).
Highlights
Prevalence of celiac disease in developed countries is assessed about 1:100–1:150
42 on 5092 children resulted affected by celiac disease, with the whole prevalence referred to subjects submitted to screening of 1:125; 0,82%
Children screened with anti-gliadin antibodies (AGA) were 4304 and among them we found 28 celiacs; children screened with antitransglutaminase IgA (ATTG) were 788 and we found 14 celiacs: the percentage of celiacs diagnosed with AGA was 0,7% (1:143), while the percentage of celiacs identified with ATTG was 1,8% (1:55), about three times higher (Figure 3) “Results of screening”
Summary
Prevalence of celiac disease in developed countries is assessed about 1:100–1:150. The real prevalence is unknown because mass screenings are expensive and difficult to organize. Celiac disease can affect people at every age and studies on asymptomatic subjects at different ages are not comparable. Age of people to be screened: celiac disease can affect people at every age; costs and arrangement of a population screening; choice of tests; management of potential celiacs (subjects positive for serology and negative for histology), and low compliance to gluten free diet in silent celiacs (subjects positive to serology and histology but asymptomatic). Serological tests used for screening in different studies are: anti-gliadin antibodies (AGA) IgA or IgG, antitransglutaminase antibodies (ATTG) and anti-endomysial antibodies (EMA). They have a different sensitivity and specificity
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