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The Prevalence of the Celiac Disease in Patients with Dyspepsia: A Systematic Review and Meta-Analysis

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Abstract

Background

Patients with celiac disease (CeD) can commonly present with symptoms of dyspepsia. We conducted a systematic review and meta-analysis of the present literature to assess the prevalence of CeD in patients diagnosed with dyspepsia.

Methods

We searched MEDLINE and EMBASE databases for the keywords: celiac disease, coeliac disease, anti-gliadin, tissue transglutaminase antibody, anti-endomysial antibody, dyspepsia and functional gastrointestinal disorder. All the studies published from January 1991 till May 2021 were included. Diagnosis of CeD was based on the European Society of Pediatric Gastroenterology, Hepatology and Nutrition guidelines. A random-effects model was used to pool the data.

Results

Twenty-one studies screening 10,275 patients with dyspepsia were included. The pooled seroprevalence of CeD based on a positive anti-tissue transglutaminase antibody and/or anti-endomysial antibody was 4.8% (95% CI [2.8, 6.7%], I2 = 87.7%). The pooled biopsy-confirmed CeD prevalence was 1.5% (95% CI [1.0, 1.9%]; I2 = 59.8%) in these patients. Both seroprevalence (Odds ratio: 1.8; 95% CI [0.8, 4.0%]; I2 = 0%) and prevalence of biopsy-confirmed CeD (Odds ratio: 1.4; 95% CI [0.8, 2.4]; I2 = 0%) were not higher in patients with dyspepsia compared to controls. There was a moderate risk of selection bias and significant heterogeneity in the pooled results.

Conclusions

The pooled prevalence of CeD in patients with dyspepsia was 1.5% and it was not significantly higher than the general population. These results do not support screening of patients with dyspepsia for CeD.

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Author notes

  1. Achintya D. Singh and Samia Ellias have contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA

    Achintya D. Singh

  2. Department of Gastrointestinal Surgery, Mayo Clinic, Rochester, MN, USA

    Samia Ellias

  3. Department of Gastroenterology, University of Michigan, Ann Arbor, MI, USA

    Prashant Singh

  4. Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India

    Vineet Ahuja & Govind K. Makharia

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  1. Achintya D. Singh
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Appendix: Search Strategy

Appendix: Search Strategy

Ovid MEDLINE(R) ALL < 1946 to December 11, 2020 > 

Embase < 1974 to 2020 December 10 > (Updated May 10, 2021).

  1. 1.

    celiac disease.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 61164

  2. 2.

    coeliac disease.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 16131

  3. 3.

    gluten.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 36693

  4. 4.

    gliadin.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 11878

  5. 5.

    tissue transglutaminase.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 9027

  6. 6.

    endomysium.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 5163

  7. 7.

    anti-endomysial antibody.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 304

  8. 8.

    sprue.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 6187

  9. 9.

    intestinal atrophy.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 402

  10. 10.

    1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 984561

  11. 11.

    limit 10 to yr = "1990 -Current" 70580

  12. 12.

    dyspepsia.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 56119

  13. 13.

    epigastric pain.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 29022

  14. 14.

    satiety.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 33672

  15. 15.

    upper gastrointestinal symptoms.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 2758

  16. 16.

    nausea.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 414540

  17. 17.

    post prandial fullness.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 168

  18. 18.

    refractory dyspepsia.mp. [mp = ti, ab, tx, ct, ot, nm, hw, fx, kf, ox, px, rx, ui, sy, tn, dm, mf, dv, kw, dq] 24

  19. 19.

    12 or 13 or 14 or 15 or 16 or 17 or 18504127

  20. 20.

    limit 19 to yr = "1990 -Current" 469010

  21. 21.

    11 and 203048

  22. 22.

    remove duplicates from 212608

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Singh, A.D., Ellias, S., Singh, P. et al. The Prevalence of the Celiac Disease in Patients with Dyspepsia: A Systematic Review and Meta-Analysis. Dig Dis Sci 67, 3067–3079 (2022). https://doi.org/10.1007/s10620-021-07142-8

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