Prevalence Of Undiagnosed Celiac Disease Research Articles

High Prevalence of Celiac Disease Among Danish Adolescents: A Population-based Study.

The objective of this study was to establish an unselected cohort of Danish adolescents and estimate the prevalence of undiagnosed celiac disease (CeD). The Glutenfunen cohort participants were recruited from an unselected subsample of the Danish National Birth Cohort, defined as participants living in the Island of Funen, Denmark. We invited all 7431 eligible participants in the age range of 15 to 21 years to a clinical visit. CeD diagnosis was based on screening with IgA transglutaminase antibodies (TG2-IgA) and if positive, was followed by duodenal biopsies compatible with CeD (Marsh 2-3). We calculated the prevalence of CeD in the Glutenfunen cohort as the number of CeD cases diagnosed before and during the study divided by the number of participants in the Glutenfunen cohort. We included 1266 participants in the Glutenfunen cohort (17%, 1266/7431). 1.1% (14 of 1266 participants) had CeD diagnosed before entering the cohort and based on the Danish National Patient Register, 0.2% of the nonparticipants (14 of 6165) had a diagnosis of CeD. In total, 2.6% (33 participants) had TG2 IgA above the upper limit of normal. Nineteen participants had duodenal biopsies compatible with CeD. The prevalence of CeD in the Glutenfunen cohort was 2.6% [(14 + 19)/1266]. Our study suggests that CeD is much more common than expected among Danish adolescents, comparable to other European countries, and that the majority were asymptomatic or oligosymptomatic and were only found because of the screening procedure.

THE RELATIONSHIP BETWEEN THYROID HORMONES, ANTITHYROID ANTIBODIES, ANTI-TISSUE TRANSGLUTAMINASE AND ANTI-GLIADIN ANTIBODIES IN PATIENTS WITH HASHIMOTO'S THYROIDITIS.

Hashimoto's thyroiditis is in coexistence with many autoimmune disorders, especially celiac disease. There are a limited number of studies evaluating the prevalence of celiac-related antibodies in patients with Hashimoto's thyroiditis. This study aimed to further investigate the prevalence of undiagnosed celiac disease in patients with Hashimoto's thyroiditis and the relationship between these two autoimmune disorders in these patients. This study was performed on 82 women aged 20-50 years including 40 patients with Hashimoto's thyroiditis and 42 healthy age-matched individuals. Anthropometric assessments were performed and biochemical parameters including thyroid hormones (TSH, T3 and T4), antithyroid antibodies, anti-tissue transglutaminase and anti-gliadin antibodies were measured by enzyme linked immunosorbent assay (ELISA). The prevalence of IgG and IgA anti-tissue transglutaminase antibodies and IgA anti-gliadin antibody was higher in Hashimoto's thyroiditis patients compared with control group (15% vs. 7%, 22.5% vs. 17% and 15% vs. 12% respectively). In ordinal regression model, serum IgG anti-tissue transglutaminase and IgA anti-gliadin antibodies were significant predictors of antithyroid antibodies in patients with Hashimoto's thyroiditis (P < 0.05). A significant relationship between serum TSH and IgG anti-gliadin antibody were also found (P = 0.003). To our findings, a high prevalence of anti-tissue transglutaminase and IgA anti-gliadin antibodies and their positive relationship with antithyroid antibodies in patients with Hashimoto's thyroiditis were reported. These findings further warrant the need for interventions to reduce the prevalence of these antibodies in Hashimoto's thyroiditis for preventing the occurrence of celiac disease in these patients.

Prevalence and Morbidity of Undiagnosed Celiac Disease From a Community-Based Study

Little is known about the prevalence and burden of undiagnosed celiac disease in individuals younger than age 50. We determined the prevalence and morbidity of undiagnosed celiac disease in individuals younger than age 50 in a community. We tested sera from 31,255 residents of Olmsted County, Minnesota (<50 y), without a prior diagnosis of celiac disease assay using an assay for IgA against tissue transglutaminase; in subjects with positive test results, celiac disease was confirmed using an assay for endomysial IgA. We performed a nested case-control study to compare the proportion of comorbidities between undiagnosed cases of celiac disease and age- and sex-matched seronegative controls (1:2). Medical records were abstracted to identify potential comorbidities. We identified 338 of 30,425 adults with positive results from both serologic tests. Based on this finding, we estimated the prevalence of celiac disease to be 1.1% (95% confidence interval, 1.0%-1.2%); 8 of 830 children tested positive for IgA against tissue transglutaminase (1.0%; 95% confidence interval, 0.4%-1.9%). No typical symptoms or classic consequences of diagnosed celiac disease (diarrhea, anemia, or fracture) were associated with undiagnosed celiac disease. Undiagnosed celiac disease was associated with increased rates of hypothyroidism (odds ratio, 2.2; P < .01) and a lower than average cholesterol level (P= .03) and ferritin level (P= .01). During a median follow-up period of 6.3 years, the cumulative incidence of a subsequent diagnosis with celiac disease at 5 years after testing was 10.8% in persons with undiagnosed celiac disease vs 0.1% in seronegative persons (P< .01). Celiac disease status was not associated with overall survival. Based on serologic tests of a community population for celiac disease, we estimated the prevalence of undiagnosed celiac disease to be 1.1%. Undiagnosed celiac disease appeared to be clinically silent and remained undetected, but long-term outcomes have not been determined.

The prevalence of celiac disease in children and adolescents in Germany.

Untreated celiac disease is associated with increased morbidity and mortality. Until now, no up-to-date figures have been available on the prevalence of celiac disease among children and adolescents in Germany, or on the percentage of undiagnosed cases. To estimate the prevalence of celiac disease, serum samples obtained from 2003 to 2006 from participants in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were studied for celiac disease-specific autoantibodies and total IgA. Of the 12 741 study participants aged 1 to 17 years (6546 boys, 6195 girls), 9 (0.07%) had a reported history of celiac disease. An elevated concentration of serum autoantibodies to tissue transglutaminase was found in 91 children with a normal IgA concentration and in 7 with IgA deficiency. The prevalence of undiagnosed celiac disease, based on positive autoantibody findings, was 0.8% (95% confidence interval 0.6-1.0%), and the overall prevalence of the disease was 0.9%. Seropositive children and adolescents had lower ferritin and red blood cell folate concentrations than seronegative ones; they also tended to be shorter and to weigh less as reflected by age- and sex-standardized z-scores. The 0.9% prevalence of celiac disease in Germany, as determined from a combination of serological findings and clinical histories, is similar to reported prevalences elsewhere in Europe and North America. Pediatricians, primary care physicians, internists, and other specialists should be aware of the broad spectrum of clinical manifestations of this disease. Children who have symptoms suggestive of celiac disease or belong to a group at risk for it should be tested for antibodies against tissue transglutaminase, as should symptomatic adults after the exclusion of other possible causes. It is not yet clear whether asymptomatic adults from high-risk groups should be tested.

Gastro-oesophageal reflux symptoms and coeliac disease: no role for routine duodenal biopsy.

Coeliac disease (CD) has been linked to gastro-oesophageal reflux disease (GORD). Previous studies have demonstrated an increased prevalence of reflux in patients with CD. However data on the risk for CD in patients presenting with reflux are conflicting. The aim of this study was to establish the prevalence of CD in patients with GORD and to elucidate the mechanisms for reflux symptoms in newly diagnosed CD patients. Group A: patients who had undergone routine duodenal biopsy were prospectively recruited between 2004 and 2014. Diagnostic yield was compared with that of a screening cohort. Group B: 32 patients with newly diagnosed CD who had undergone oesophageal manometry and 24-h pH studies were prospectively recruited. Group A: 3368 patients (58.7% female, mean age 53.4 years) underwent routine duodenal biopsy. Of these patients, 850 (25.2%) presented with GORD. The prevalence of CD among GORD patients was 1.3% (0.7-2.4%), which was not significantly higher than that in the general population (P=0.53). Within the context of routine duodenal biopsy at endoscopy (when corrected for concurrent symptoms, age and sex), reflux was found to be negatively associated with CD [adjusted odds ratio 0.12 (0.07-0.23), P<0.0001]. In group B, 34% of patients complained of reflux. On manometry, 9% had a hypotensive lower oesophageal sphincter and 40.6% had oesophageal motor abnormalities, with 25% significantly hypocontractile. On pH studies, 33% demonstrated reflux episodes. The prevalence of undiagnosed CD among GORD patients is similar to that in the general population, and routine duodenal biopsy cannot be recommended. A significant number of patients with newly diagnosed CD were found to have reflux and/or oesophageal dysmotility on pH/manometry studies; this may explain the high prevalence of reflux symptoms in CD.

Risk of infertility in patients with celiac disease: a meta-analysis of observational studies.

Celiac disease is an autoimmune disorder of the small intestine associated with several extra-intestinal features, such as reproductive disorders. The relationship between celiac disease and infertility has been previously assessed, with conflicting results. We seek to determine the relationship between celiac disease and infertility. Data was extracted from case-control or cohort design studies from 1966 to December 2013 using the MEDLINE-Pubmed, EMBASE, LILACS and Cochrane Library databases. We analyzed two kinds of trials: those assessing the risk of infertility in subjects with already diagnosed celiac disease, and those evaluating the prevalence of undiagnosed celiac disease in subjects with a diagnosis of infertility. The search yielded 413 potentially relevant studies for revision, 12 of which were finally included for analysis. A significant association was found between women with a diagnosis of infertility and undiagnosed celiac disease [OR 3.09 (95% CI 1.74-5.49)]. When considering those studies assessing the occurrence of infertility in subjects with already-diagnosed celiac disease, no difference was found between celiac disease patients and control subjects [OR 0.99 (0.86-1.13)]. Undiagnosed celiac disease is a risk factor for infertility. Women seeking medical advice for this particular condition should be screened for celiac disease. Adoption of a gluten-free diet could have a positive impact on fertility in this group of patients.

Increased prevalence of undiagnosed celiac disease among women with recurrent pregnancy loss: experience in Spain

Increased prevalence of undiagnosed celiac disease among women with recurrent pregnancy loss: experience in Spain

Usefulness of tissue transglutaminase type 2 antibodies in early pregnancy

Celiac disease (CD), an autoimmune disease triggered by dietary gluten, is a multi-systemic disorder that primarily results in mucosal damage of the small intestine. Reproductive disorders and pregnancy complications have been associated with CD. Conflicting results have been published concerning CD and the risk of impaired fetal growth with reduced birthweight. The aim of our multicentric, perspective, case–control study was to determine the prevalence of undiagnosed CD in mothers of small for gestational age (SGA) newborns in two regions of Italy. The study included 480 mothers: group A consisted of 284 SGA newborns’ mothers and group B consisted of 196 appropriate for gestational age (AGA) newborns’ mothers. Tissue transglutaminase type 2 antibodies (TG2) IgA and IgG were measured in blood samples. We diagnosed two new cases of CD in asymptomatic mothers. It may be appropriate to include the TG2 to the panel of prenatal blood test.

Exploring Celiac Disease Outcomes in the Community: Melting the Celiac Iceberg?: 2010 ACG Auxiliary Award

Purpose: Clinically diagnosed celiac disease (CD) patients carry an increased risk of complications and mortality. CD is markedly under recognized. We evaluated the prevalence as well as morbidity and mortality of undiagnosed CD as compared to incident cases of clinically diagnosed CD in Olmsted County, Minnesota Methods: Blood samples from 35,299 Olmsted County adults collected between 1995 and 2006 were tested for immunoglobulin A tissue transglutaminase antibodies (tTGA) in 2006 to 2008. A tTGA test <2.0 U/ml was considered negative. Subjects with tTGA test >2.0 U/ml were further analyzed for endomysial antibodies. Undiagnosed CD was established if tTGA test >2.0 U/ml and subsequent EMA positive. For comparison, we used an incident cohort of adults with clinically diagnosed CD in Olmsted County from 1995 to 2008 identified via the Rochester Epidemiology Project. Medical records were reviewed for laboratory measurements, comorbid conditions, and mortality. Logistic regression was used to test for an association between CD group and clinical characteristics, adjusted for age, gender, and calendar year of CD assessment. Results: We identified 327 (0.93%) subjects with undiagnosed CD. Ten subjects with undiagnosed CD and 8 patients with clinically diagnosed CD were excluded from further analysis due to lack of research authorization of their medical records. Twenty-one subjects with undiagnosed CD had a subsequent clinical diagnosis of CD and were included in the clinically diagnosed group. Thus, a total of 296 undiagnosed CD cases (56% female, median age 45.5 years) and 150 clinically diagnosed CD cases (67% female, median age 44.9 years) were compared. Subjects with clinically diagnosed CD had significantly lower body weight (median 71.3 vs. 78.0, p=.001), body mass index (24.6 vs. 26.9, p<.001), cholesterol (176 vs. 186.5, p=.001), ferritin (18 vs. 30, p=.001), and hemoglobin (12.9 vs. 13.9, p<.001). Lumbar spine bone density (T-score) was lower among undiagnosed CD subjects (-1.6 vs. -0.9, p=.01). The number of deaths in the 5 years following CD assessment was low in both the clinically diagnosed CD and undiagnosed CD group (5-year Kaplan-Meier survival rates 98% and 94%, respectively). Conclusion: The prevalence of undiagnosed CD was 0.93%, suggesting that a substantial number with CD remain unrecognized in the community. Relative to undiagnosed CD, clinically diagnosed CD was significantly associated with some potential markers of morbidity. These findings suggest that screening could detect undiagnosed CD in the community before some morbidity may occur.

Guest Family Physician Commentaries

<h3>BACKGROUND</h3> Up to 50% of women with untreated coeliac disease experience miscarriage or an unfavourable outcome of pregnancy. In most cases, after 6–12 months of a gluten free diet, no excess of unfavourable outcome of pregnancy is observed. The prevalence of undiagnosed coeliac disease among pregnant women is not known. <h3>AIM</h3> To determine the prevalence of untreated coeliac disease among women attending the obstetrics-gynaecological department. <h3>METHODS</h3> Endomysial antibodies, which are specific and sensitive for coeliac disease, were evaluated in all women attending the obstetrics-gynaecology department of a large city hospital over a 90 day period. <h3>RESULTS</h3> Of 845 pregnant women screened, 12 were identified as having coeliac disease. Three had previously been diagnosed but were not following a gluten free diet. The remaining nine underwent a small intestinal biopsy, which confirmed the diagnosis. The outcome of pregnancy was unfavourable in seven of these 12 women. Six healthy babies were born with no problems after the women had been on a gluten free diet for one year. <h3>CONCLUSIONS</h3> Overall, 1 in 70 women was affected by coeliac disease, either not diagnosed (nine cases) or not treated (three cases). Their history of miscarriages, anaemia, low birth weight babies, and unfavourable outcome of pregnancy suggests that testing for coeliac disease should be included in the battery of tests prescribed for pregnant women. Coeliac disease is considerably more common than most of the diseases for which pregnant women are routinely screened. Unfavourable events associated with coeliac disease may be prevented by a gluten free diet.

Prevalence and Associated Morbidity of Undiagnosed Celiac Disease in Young Adults

Purpose: Celiac Disease (CD) is an autoimmune disorder of the proximal small intestine which induces inflammatory cascades that damage the absorptive villous architecture of the small intestine. Hallmark symptoms of the resulting malabsorption are diarrhea, steatorrhea, and flatulence along with malabsorption consequences including growth failure, anemia, fracture, and weight loss. In addition, the autoimmune properties of CD have been associated with hepatitis, diabetes, thyroid disorders, and many other autoimmune conditions. CD is likely common, but the majority of patients are undiagnosed at any point in time. It is not known whether these individuals suffer any manifestations from silent or undiagnosed CD. Prior studies using the Rochester Epidemiology Project have identified all diagnosed cases of CD in Olmsted County, MN residents. Methods: In the present study, we estimate prevalence of undiagnosed CD in a convenience sample obtained from the ˜67,000 Olmsted County residents' ages of 18-50. An initial screening tissue transglutaminase IgA (tTG-IgA) assay, with confirmation via endomysial antibody immunofluorescence was done on waste blood samples from 19,671 unique individuals. Subjects were categorized as positive (cases) or negative according to their serology result. A 1:2 matched (on age and gender) set of controls was obtained from those with negative serology. The risk of various co-morbidities at or prior to the serum draw in undiagnosed sero-positive cases was compared to matched controls using conditional logistic regression. Odds ratios (OR) with 95% confidence intervals (CI) are reported as a measure of the strength of associations between co-morbidity and serology status. Results: The prevalence of undiagnosed CD in the cohort of Olmsted County residents age 18-50 was 1.1% (95% CI=1.0%-1.3%) which reflects the estimated prevalence of undiagnosed celiac disease in the general population in this age range. None of the hallmark symptoms and consequences of classic CD including diarrhea, anemia, and fracture were increased in the sero-positive subjects. However, the sample of Olmsted County residents with undiagnosed CD were found to have increased odds for chronic fatigue (OR=1.90; 95% CI, 1.1-3.4; p=0.031) and hypothyroidism (OR=2.13; 95% CI, 1.1-4.2; p=0.033) among the ˜80 co-morbidities assessed. Conclusion: Overall, this preliminary analysis reveals no consistent constellation of patient co-morbidities associated with sero-positive status in a community sample of Olmsted County residents age 18-50. Undiagnosed CD in this population-based cohort appears largely silent.

Increased Prevalence and Mortality in Undiagnosed Celiac Disease

The historical prevalence and long-term outcome of undiagnosed celiac disease (CD) are unknown. We investigated the long-term outcome of undiagnosed CD and whether the prevalence of undiagnosed CD has changed during the past 50 years. This study included 9133 healthy young adults at Warren Air Force Base (sera were collected between 1948 and 1954) and 12,768 gender-matched subjects from 2 recent cohorts from Olmsted County, Minnesota, with either similar years of birth (n = 5558) or age at sampling (n = 7210) to that of the Air Force cohort. Sera were tested for tissue transglutaminase and, if abnormal, for endomysial antibodies. Survival was measured during a follow-up period of 45 years in the Air Force cohort. The prevalence of undiagnosed CD between the Air Force cohort and recent cohorts was compared. Of 9133 persons from the Air Force cohort, 14 (0.2%) had undiagnosed CD. In this cohort, during 45 years of follow-up, all-cause mortality was greater in persons with undiagnosed CD than among those who were seronegative (hazard ratio = 3.9; 95% confidence interval, 2.0-7.5; P < .001). Undiagnosed CD was found in 68 (0.9%) persons with similar age at sampling and 46 (0.8%) persons with similar years of birth. The rate of undiagnosed CD was 4.5-fold and 4-fold greater in the recent cohorts, respectively, than in the Air Force cohort (both P < or = .0001). During 45 years of follow-up, undiagnosed CD was associated with a nearly 4-fold increased risk of death. The prevalence of undiagnosed CD seems to have increased dramatically in the United States during the past 50 years.

The Significance of Coeliac Disease Antibodies in Patients with Ankylosing Spondylitis: A Case-Controlled Study

The presence of anti-gliadin antibodies (AGA) and their relationship with intestinal permeability and prevalence of undiagnosed coeliac disease (CD) in ankylosing spondylitis (AS) were investigated. Blood samples from 30 AS patients and 19 age- and sex-matched controls were analysed for human leucocyte antigen (HLA)-B27, AGA and endomysial antibodies (EMA). Immunoglobulin (Ig) A-type AGA and IgG-type EMA were determined by enzyme-linked immunosorbent assay. AGA-positive patients were examined by gastroduodenoscope and proximal small bowel mucosa biopsies were performed. Eleven (36.7%) AS patients were AGA positive (compared with none of the control subjects) and three (10.0%) of these AS patients were also EMA-positive. The presence of AGA was not associated with more severe AS. Mild-to-severe villous atrophy and hyperplasia of crypts with increased chronic inflammatory cells in the lamina propria, which is typical of CD, was only observed in one AGA/EMA positive AS patient; CD was subsequently diagnosed by histology. Although AGA positivity might contribute to the pathogenesis of AS by increasing intestinal permeability to micro-organisms or by modifying intestinal immune mechanisms, further work is required to clarify its role in AS.

Reduced Chemokine Receptor 9 on Intraepithelial Lymphocytes in Celiac Disease Suggests Persistent Epithelial Activation

Celiac disease is caused by an inappropriate immune response to dietary gluten, with increased epithelial lymphocyte infiltration in the duodenum/jejunum as a hallmark. The chemokine receptor 9 (CCR9) is a small intestinal homing receptor normally found on most mucosal T cells in this organ. Because CCR9 expression appears to be activation dependent, we examined CCR9 on duodenal T cells from untreated and treated (gluten-free diet) patients with celiac disease and healthy controls. Duodenal biopsy specimens and blood samples were obtained for histologic analysis and flow-cytometric CCR9 analysis of isolated lymphocytes. CCR9 expression after activation was studied in peripheral blood T cells from healthy volunteers. The median number of CCR9(+) cells among CD3(+) T cells in epithelium and lamina propria, respectively, was 56% and 48% in controls, 11% and 40% in treated patients, and 1% and 8% in untreated patients. Significant differences occurred between controls and treated or untreated patients in the epithelium but only between controls and untreated patients in the lamina propria (P=.008, all comparisons). No such differences were seen in peripheral blood, but stimulation with phorbol myristate acetate and ionomycin and, to a lesser extent, stimulation via NKG2D reduced the CCR9 expression on blood T cells. CCR9 expression is reduced on epithelial and lamina propria T cells in untreated celiac disease. Down-regulation of CCR9 persists in intraepithelial T cells from well-treated patients. This suggests ongoing immune activation preferentially within the epithelium.

Prevalence of Undiagnosed Celiac Disease in the Parents of Preterm and/or Small for Gestational Age Infants

The aim of this study was to estimate the prevalence of undiagnosed celiac disease (CD) in the parents of preterm and/or small for gestational age (SGA) infants. A sample of 1,714 parents (868 women, 846 men) of 905 preterm (<37 wk of gestational age) and/or SGA (<10th percentile of birthweight) infants consecutively born in Lombardy, Northern Italy, and not diagnosed with CD prior to pregnancy, were tested for CD. Diagnosis was based on antitissue transglutaminase and anti-endomysial antibodies and confirmed by duodenal biopsy. The overall prevalence of undiagnosed CD was 0.64% (95% confidence interval [CI] 0.32-1.15%), 0.92% (0.40-1.81%) in women and 0.35% (0.07-1.03%) in men. In the mothers of preterm infants prevalence of CD was 0.39% (0.05-1.39%). In the mothers of SGA infants prevalence of CD was 1.60% (0.64-3.27%), and the observed number of mothers with CD was 2.25 times higher than the expected one in the Italian female population (P = 0.039). Undiagnosed CD in mothers was associated with an increased risk of SGA birth (odds ratio 6.97, 95% CI 1.11-43.55%). While additional powered studies are needed, the present results suggest that the prevalence of undiagnosed CD in the mothers of SGA infants is higher than in the general female population.

Celiac Disease Presenting as Resistant Hypothyroidism

The high prevalence of celiac disease in patients with autoimmune hypothyroidism, compared to the general population, has been well documented but screening for celiac disease is not recommended as yet in otherwise asymptomatic hypothyroid patients. In recent years the high prevalence of undiagnosed celiac disease in the general population, largely as a result of the many atypical manifestations of the disease, has become apparent. We report the case of a 58-year-old woman with autoimmune hypothyroidism who was initially suspected of having celiac disease on the basis of apparent resistance to levothyroxine therapy, and who had no other clinical or laboratory clues to suggest the diagnosis. Cases of undiagnosed celiac disease causing levothyroxine malabsorbtion have previously been described, but all previous cases had other obvious manifestations of the disease. We believe that this atypical presentation of celiac disease warrants further attention, and that the diagnosis of celiac disease should always be considered in patients requiring higher than expected doses of thyroid hormone replacement, even in patients with normal bowel habit, and no other apparent manifestations of the disease.

Serological screening for undiagnosed coeliac disease in male adolescents in Lower Austria

There is a wide variation in the clinical manifestations of coeliac disease (CD). Several recent screening investigations have attempted to determine the true prevalence of CD and rates of undiagnosed CD between 1:22 [3] and 1:1170 [5] have been reported. As there are no data on the prevalence of undiagnosed CD in Austria, the aim of our study was to establish the frequency of positive tissue transglutaminase antibodies (tTGA) in a cohort of male adolescents. During the compulsory conscript medical examination (June 2001–July 2002), an additional blood sample C. Edlinger-Horvat AE D. Fidler AE W.-D. Huber AE B. Rami G. Granditsch AE E. Schober (&) Department of Paediatrics, University Children’s Hospital, Waehringer Guertel 18–20, 1090 Vienna, Austria E-mail: edith.Schober@akh-wien.ac.at Tel.: +43-1-404003232 Fax: +43-1-40400 3238

P0410 SCREENING FOR COELIAC DISEASE IN RISK GROUPS IN CUBA

Introduction: The association between type 1 diabetes mellitus, Down’s syndrome and coeliac disease (CD) was recognized years ago and increased prevalence of CD has been observed with the use of serologic antibody methods against CD. There is a prevalence of 0,97–16.4% in pediatric patients with type 1 diabetes mellitus and between 2.5–18.6% in Down’s syndrome patients. These results appear in studies carried out in North America and Europe. In Latin America the prevalence among risk groups has not been well studied. The objective of our study has been to determine CD antibodies in these two main risk groups in Cuba. Methods: A total of 510 children and adolescents (247 type 1 diabetes mellitus and 263 Down’s syndrome) were evaluated using antigliadin and antitransglutaminase antibodies produced by the Genetic Engineering and Biotechnology Center in Havana. The antigliadin antibodies (AGAs)was determined using a novel visual immunoassay (kit AuBio Dot antigliadin, Heber Biotech, Havana, Cuba) utilizing strips of 8 polystyrene coated with wheat gliadin; a conjugate of protein A- colloidal gold is added to the serum to be tested. The strips are read by visual inspection as described by Garete, Sorell and Alfonso in 1999. All the AGA positive subjects were tested for Anti tissue transglutaminase (tTG) antibodies using a one-step immunochromatographic assay that takes about 10 minutes. Results: We found that out of the 247 type 1 diabetes, 47 were AGA positive (19%). Out of all these AGA positive subjects tested for anti tTg, only 6 were positive (12.7%). Of the 263 patients with Down’s syndrome, we found that 63 were tested as AGA positive (23.9%); of these only 6 were anti tTg positive (2.2%). All the anti tTg positive cases have been notified of the need to carry out jejunum biopsies to determine CD. Conclusion: This report provides further confirmation of the prevalence of undiagnosed coeliac disease among type 1 diabetes mellitus and Down’s syndrome patients, very similar to what appears in other reports. The possibility of having developed in our country modern serologic methods has made it possible for us to screen CD in pediatric gastroenterology medical practice and the research among risk groups, which is of interest and importance for Latin America, as an expression of the need to carry out these studies in developing countries where CD is rarely diagnosed.

Undiagnosed coeliac disease at age seven: population based prospective birth cohort study

Coeliac disease is uncommon in childhood and diagnosed in fewer than 1 in 2500 children in the United Kingdom.1 Subclinical disease is, however, common in adults, and can be detected...

A prospective study of the prevalence of undiagnosed coeliac disease in laboratory defined iron and folate deficiency

Aims: To determine the prevalence of coeliac disease in a group of patients in the community who have been shown in the laboratory to have iron and/or folate deficiency. To...