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Epidemiology and clinical presentations of celiac disease

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Abstract

Evidence of the prevalence of celiac disease comes from serological screening studies. These have revealed that celiac disease is common, occurring in about 1 % of the population worldwide. There are some countries with higher prevalence rates such as Finland and others with lower rates, for example Germany. The disease is found in most continents and appears to be increasing. Most people with the disease are not currently diagnosed though women are diagnosed more frequently than men. The mode of presentation has changed both in children and adults with diarrhea and a malabsorption syndrome becoming less common. Abdominal pain and growth issues are major modes of presentation in children, while anemia, osteoporosis, and recognition at endoscopy performed for GERD are seen as modes of presentation in adults. Screening of at risk groups is a major mode of presentation for both adults and children.

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References

  1. West J et al (2003) Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut 52(7):960–965

    Article  PubMed  CAS  Google Scholar 

  2. Maki M et al (2003) Prevalence of celiac disease among children in Finland. N Engl J Med 348(25):2517–2524

    Article  PubMed  Google Scholar 

  3. Tatar G et al (2004) Screening of tissue transglutaminase antibody in healthy blood donors for celiac disease screening in the Turkish population. Dig Dis Sci 49(9):1479–1484

    Article  PubMed  CAS  Google Scholar 

  4. Fasano A et al (2003) Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 163(3):286–292

    Article  PubMed  Google Scholar 

  5. Bingley PJ et al (2004) Undiagnosed coeliac disease at age seven: population based prospective birth cohort study. BMJ 328(7435):322–323

    Article  PubMed  Google Scholar 

  6. Katz KD et al (2011) Screening for celiac disease in a North American population: sequential serology and gastrointestinal symptoms. Am J Gastroenterol 106(7):1333–1339

    Article  PubMed  Google Scholar 

  7. Hovell CJ et al (2001) High prevalence of coeliac disease in a population-based study from Western Australia: a case for screening? Med J Aust 175(5):247–250

    PubMed  CAS  Google Scholar 

  8. Cook HB et al (2000) Adult coeliac disease: prevalence and clinical significance. J Gastroenterol Hepatol 15(9):1032–1036

    Article  PubMed  CAS  Google Scholar 

  9. Brandt KG, Silva GA (2008) Seroprevalence of celiac disease at a general pediatric outpatient clinic. Arq Gastroenterol 45(3):239–242

    Article  PubMed  Google Scholar 

  10. Oliveira RP et al (2007) High prevalence of celiac disease in Brazilian blood donor volunteers based on screening by IgA antitissue transglutaminase antibody. Eur J Gastroenterol Hepatol 19(1):43–49

    Article  PubMed  Google Scholar 

  11. Gomez JC et al (2001) Prevalence of celiac disease in Argentina: screening of an adult population in the La Plata area. Am J Gastroenterol 96(9):2700–2704

    Article  PubMed  CAS  Google Scholar 

  12. Araya M et al (2000) Celiac disease in a Chilean population carrying Amerindian traits. J Pediatr Gastroenterol Nutr 31(4):381–386

    Article  PubMed  CAS  Google Scholar 

  13. Freeman HJ (2003) Biopsy-defined adult celiac disease in Asian-Canadians. Can J Gastroenterol 17(7):433–436

    PubMed  Google Scholar 

  14. Brar P et al (2006) Celiac disease in African-Americans. Dig Dis Sci 51(5):1012–1015

    Article  PubMed  Google Scholar 

  15. Rabassa EB et al (1981) Coeliac disease in Cuban children. Arch Dis Child 56(2):128–131

    Article  PubMed  CAS  Google Scholar 

  16. Hung JC, Phillips AD, Walker-Smith JA (1995) Coeliac disease in children of West Indian origin. Arch Dis Child 73(2):166–167

    Article  PubMed  CAS  Google Scholar 

  17. Shahbazkhani B et al (2003) High prevalence of coeliac disease in apparently healthy Iranian blood donors. Eur J Gastroenterol Hepatol 15(5):475–478

    PubMed  Google Scholar 

  18. Abu-Zekry M et al (2008) Prevalence of celiac disease in Egyptian children disputes the east–west agriculture-dependent spread of the disease. J Pediatr Gastroenterol Nutr 47(2):136–140

    Article  PubMed  CAS  Google Scholar 

  19. Catassi C et al (1999) Why is coeliac disease endemic in the people of the Sahara? Lancet 354(9179):647–648

    Article  PubMed  CAS  Google Scholar 

  20. Dinler G, Atalay E, Kalayci AG (2009) Celiac disease in 87 children with typical and atypical symptoms in Black Sea region of Turkey. World J Pediatr 5(4):282–286

    Article  PubMed  Google Scholar 

  21. Barada K et al (2010) Celiac disease in Middle Eastern and North African countries: a new burden? World J Gastroenterol 16(12):1449–1457

    Article  PubMed  Google Scholar 

  22. Sood A et al (2003) Adult celiac disease in northern India. Indian J Gastroenterol 22(4):124–126

    PubMed  Google Scholar 

  23. Bansal D et al (2011) Serodiagnosis of celiac disease in children referred for evaluation of anemia: a pediatric hematology unit’s experience. Indian J Pathol Microbiol 54(4):756–760

    PubMed  Google Scholar 

  24. Gupta V, Kohli A (2010) Celiac disease associated with recurrent Guillain Barre syndrome. Indian Pediatr 47(9):797–798

    Article  PubMed  Google Scholar 

  25. Walker MM et al (2010) Detection of celiac disease and lymphocytic enteropathy by parallel serology and histopathology in a population-based study. Gastroenterology 139(1):112–119

    Article  PubMed  Google Scholar 

  26. Remes-Troche JM et al (2008) High prevalence of celiac disease in Mexican Mestizo adults with type 1 diabetes mellitus. J Clin Gastroenterol 42(5):460–465

    Article  PubMed  CAS  Google Scholar 

  27. Lohi S et al (2007) Increasing prevalence of coeliac disease over time. Aliment Pharmacol Ther 26(9):1217–1225

    Article  PubMed  CAS  Google Scholar 

  28. Mustalahti K et al (2010) The prevalence of celiac disease in Europe: results of a centralized, international mass screening project. Ann Med 42(8):587–595

    Article  PubMed  Google Scholar 

  29. Bai D et al (2005) Effect of gender on the manifestations of celiac disease: evidence for greater malabsorption in men. Scand J Gastroenterol 40(2):183–187

    Article  PubMed  Google Scholar 

  30. Green PHR et al (2001) Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol 96(1):126–131

    Article  PubMed  Google Scholar 

  31. Vilppula A et al (2009) Increasing prevalence and high incidence of celiac disease in elderly people: a population-based study. BMC Gastroenterol 9(1):49

    Article  PubMed  Google Scholar 

  32. Vilppula A et al (2008) Undetected coeliac disease in the elderly: a biopsy-proven population-based study. Dig Liver Dis 40(10):809–813

    Article  PubMed  CAS  Google Scholar 

  33. Rubio-Tapia A et al (2009) Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology 137(1):88–93

    Article  PubMed  Google Scholar 

  34. Murray JA et al (2003) Trends in the identification and clinical features of celiac disease in a North American community, 1950–2001. Clin Gastroenterol Hepatol 1(1):19–27

    Article  PubMed  Google Scholar 

  35. Collin P et al (2007) Diagnosis of celiac disease in clinical practice: physician’s alertness to the condition essential. J Clin Gastroenterol 41(2):152–156

    Article  PubMed  Google Scholar 

  36. Green PH et al (2008) Economic benefits of increased diagnosis of celiac disease in a national managed care population in the United States. J Insur Med 40(3–4):218–228

    PubMed  Google Scholar 

  37. Telega G, Bennet TR, Werlin S (2008) Emerging new clinical patterns in the presentation of celiac disease. Arch Pediatr Adolesc Med 162(2):164–168

    Article  PubMed  Google Scholar 

  38. Andersen DH (1947) Celiac syndrome. J Pediatr 30:564–582

    Article  PubMed  CAS  Google Scholar 

  39. Dickie WK (1950) Coeliac disease. Investigation of the harmful effects of certain types of cereal on patients with coeliac disease, in Medicine. University of Utrecht, Utrecht, Thesis

    Google Scholar 

  40. Wilson R (1951) The coeliac syndrome with adolescent rickets. Ir J Med Sci 6(301):39–42

    Article  Google Scholar 

  41. Mortimer PE et al (1968) Follow-up study of coeliac disease. Br Med J 3(609):7–9

    Article  PubMed  CAS  Google Scholar 

  42. Sleisenger MH et al (1957) Treatment of non-tropical sprue: a wheat-, rye-, and oat-free diet. J Am Diet Assoc 33(11):1137–1140

    PubMed  CAS  Google Scholar 

  43. Benson GD, Kowlessar OD, Sleisenger MH (1964) Adult celiac disease with emphasis upon response to the gluten-free diet. Medicine (Baltimore) 43:1–40

    CAS  Google Scholar 

  44. Rampertab SD et al (2006) Trends in the presentation of celiac disease. Am J Med 119(4):355 e9–355 e14

    Article  Google Scholar 

  45. Vivas S et al (2008) Age-related clinical, serological, and histopathological features of celiac disease. Am J Gastroenterol 103:2360–2365

    Article  PubMed  Google Scholar 

  46. Branski D, Troncone R (1998) Celiac disease: a reappraisal. J Pediatr 133(2):181–187

    Article  PubMed  CAS  Google Scholar 

  47. Ludvigsson JF et al (2004) Symptoms and signs have changed in Swedish children with coeliac disease. J Pediatr Gastroenterol Nutr 38(2):181–186

    Article  PubMed  Google Scholar 

  48. Llorente-Alonso M, Fernandez-Acenero MJ, Sebastian M (2006) Gluten intolerance: gender and age-related features. Can J Gastroenterol 20(11):719–722

    PubMed  CAS  Google Scholar 

  49. Reilly NR et al (2011) Celiac disease in normal-weight and overweight children: clinical features and growth outcomes following a gluten-free diet. J Pediatr Gastroenterol Nutr 53(5):528–531

    PubMed  Google Scholar 

  50. Dehghani SM, Asadi-Pooya AA (2008) Celiac disease in children with short stature. Indian J Pediatr 75(2):131–133

    Article  PubMed  Google Scholar 

  51. Rizkalla Reilly N et al (2012) Celiac disease in children: an old disease with new features. Minerva Pediatr 64(1):71–81

    PubMed  CAS  Google Scholar 

  52. McGowan KE, Castiglione DA, Butzner JD (2009) The changing face of childhood celiac disease in North America: impact of serological testing. Pediatrics 124(6):1572–1578

    Article  PubMed  Google Scholar 

  53. Lo W et al (2003) Changing presentation of adult celiac disease. Dig Dis Sci 48(2):395–398

    Article  PubMed  Google Scholar 

  54. Garampazzi A et al (2007) Clinical pattern of celiac disease is still changing. J Pediatr Gastroenterol Nutr 45(5):611–614

    Article  PubMed  Google Scholar 

  55. Sun S et al (2009) The effect of biopsy-positive silent coeliac disease and treatment with a gluten-free diet on growth and glycaemic control in children with type 1 diabetes. Diabet Med 26(12):1250–1254

    Article  PubMed  CAS  Google Scholar 

  56. Savilahti E, Pelkonen P, Visakorpi JK (1971) IgA deficiency in children. A clinical study with special reference to intestinal findings. Arch Dis Child 46(249):665–670

    Article  PubMed  CAS  Google Scholar 

  57. Harper JW et al (2007) Anemia in celiac disease is multifactorial in etiology. Am J Hematol 82:996–1000

    Article  PubMed  Google Scholar 

  58. Bergamaschi G et al (2008) Anemia of chronic disease and defective erythropoietin production in patients with celiac disease. Haematologica 93:1785–1791

    Article  PubMed  CAS  Google Scholar 

  59. Rodrigo-Saez L et al (2011) Differences between pediatric and adult celiac disease. Rev Esp Enferm Dig 103(5):238–244

    PubMed  Google Scholar 

  60. Valdimarsson T et al (1994) Bone mineral density in coeliac disease. Scand J Gastroenterol 29(5):457–461

    Article  PubMed  CAS  Google Scholar 

  61. Meyer D et al (2001) Osteoporosis in a North American adult population with celiac disease. Am J Gastroenterol 96(1):112–119

    PubMed  CAS  Google Scholar 

  62. Vasquez H et al (2000) Risk of fractures in celiac disease patients: a cross-sectional, case–control study. Am J Gastroenterol 95(1):183–189

    Article  PubMed  CAS  Google Scholar 

  63. West J et al (2003) Fracture risk in people with celiac disease: a population-based cohort study. Gastroenterology 125(2):429–436

    Article  PubMed  Google Scholar 

  64. Ludvigsson JF et al (2007) Coeliac disease and the risk of fractures—a general population-based cohort study. Aliment Pharmacol Ther 25(3):273–285

    Article  PubMed  CAS  Google Scholar 

  65. Stenson WF et al (2005) Increased prevalence of celiac disease and need for routine screening among patients with osteoporosis. Arch Intern Med 165(4):393–399

    Article  PubMed  Google Scholar 

  66. Legroux-Gerot I et al (2009) Screening for celiac disease in patients with osteoporosis. Joint Bone Spine 76:162–165

    Article  PubMed  Google Scholar 

  67. Kavuncu V et al (2009) Is there any requirement for celiac disease screening routinely in postmenopausal women with osteoporosis? Rheumatol Int 29(7):841–845

    Article  PubMed  CAS  Google Scholar 

  68. Green PH et al (2000) Significance of unsuspected celiac disease detected at endoscopy. Gastrointest Endosc 51(1):60–65

    Article  PubMed  CAS  Google Scholar 

  69. Nachman F et al (2011) Gastroesophageal reflux symptoms in patients with celiac disease and the effects of a gluten-free diet. Clin Gastroenterol Hepatol 9(3):214–219

    Article  PubMed  Google Scholar 

  70. Green PH, Murray JA (2003) Routine duodenal biopsies to exclude celiac disease? Gastrointest Endosc 58(1):92–95

    PubMed  Google Scholar 

  71. Chin RL et al (2004) Neurologic complications of celiac disease. J Clin Neuromuscul Dis 5(3):129–137

    Article  PubMed  Google Scholar 

  72. Hin H et al (1999) Coeliac disease in primary care: case finding study. BMJ 318(7177):164–167

    Article  PubMed  CAS  Google Scholar 

  73. Catassi C et al (2007) Detection of celiac disease in primary care: a multicenter case-finding study in North America. Am J Gastroenterol 102(7):1454–1460

    Article  PubMed  Google Scholar 

  74. Sanders DS et al (2005) Association of adult celiac disease with surgical abdominal pain: a case–control study in patients referred to secondary care. Ann Surg 242(2):201–207

    Article  PubMed  Google Scholar 

  75. Gonda TA et al (2010) Association of intussusception and celiac disease in adults. Dig Dis Sci 55(10):2899–2903

    Article  PubMed  Google Scholar 

  76. Sanders DS et al (2004) Symptomatic small bowel intussusception: a surgical opportunity to diagnose adult celiac disease? Gastrointest Endosc 59(1):161–162

    Article  PubMed  Google Scholar 

  77. Aggarwal S, Lebwohl B, Green PH (2012) Screening for celiac disease in average-risk and high-risk populations. Ther Adv Gastroenterol 5(1):37–47

    Article  Google Scholar 

  78. Murray JA (2005) Celiac disease in patients with an affected member, type 1 diabetes, iron-deficiency, or osteoporosis? Gastroenterology 128(4 Pt 2):S52–S56

    Article  PubMed  Google Scholar 

  79. Book L, Zone JJ, Neuhausen SL (2003) Prevalence of celiac disease among relatives of sib pairs with celiac disease in U.S. families. Am J Gastroenterol 98(2):377–381

    Article  PubMed  Google Scholar 

  80. Dickey W, McMillan SA (1998) Co-screening for primary biliary cirrhosis and coeliac disease. Association between primary biliary cirrhosis and coeliac disease. Gut 43(2):300

    Article  PubMed  CAS  Google Scholar 

  81. Volta U et al (2002) Celiac disease in autoimmune cholestatic liver disorders. Am J Gastroenterol 97(10):2609–2613

    Article  PubMed  Google Scholar 

  82. Brar P et al (2007) Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease. Dig Liver Dis 39(1):26–29

    Article  PubMed  CAS  Google Scholar 

  83. Murray JA et al (2008) Mucosal atrophy in celiac disease: extent of involvement, correlation with clinical presentation, and response to treatment. Clin Gastroenterol Hepatol 6(2):186–193, quiz 125

    Article  PubMed  Google Scholar 

  84. Coleman NS et al (2006) Abnormalities of serotonin metabolism and their relation to symptoms in untreated celiac disease. Clin Gastroenterol Hepatol 4(7):874–881

    Article  PubMed  CAS  Google Scholar 

  85. Carlsson AK et al (1999) Prevalence of IgA-antiendomysium and IgA-antigliadin autoantibodies at diagnosis of insulin-dependent diabetes mellitus in Swedish children and adolescents. Pediatrics 103(6 Pt 1):1248–1252

    Article  PubMed  CAS  Google Scholar 

  86. Walsh CH et al (1978) Diabetes mellitus and coeliac disease: a clinical study. Q J Med 47(185):89–100

    PubMed  CAS  Google Scholar 

  87. Bouguerra R et al (2005) Celiac disease in adult patients with type 1 diabetes mellitus in Tunisia. Diabetes Metab 31(1):83–86

    Article  PubMed  CAS  Google Scholar 

  88. Sategna-Guidetti C et al (2001) Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study. Am J Gastroenterol 96(3):751–757

    Article  PubMed  CAS  Google Scholar 

  89. Sategna-Guidetti C et al (1998) Autoimmune thyroid diseases and coeliac disease. Eur J Gastroenterol Hepatol 10(11):927–931

    Article  PubMed  CAS  Google Scholar 

  90. Sattar N et al (2011) Celiac disease in children, adolescents, and young adults with autoimmune thyroid disease. J Pediatr 158(2):272–5 e1

    Article  PubMed  Google Scholar 

  91. Caprai S et al (2008) Autoimmune liver disease associated with celiac disease in childhood: a multicenter study. Clin Gastroenterol Hepatol 6(7):803–806

    Article  PubMed  Google Scholar 

  92. Diamanti A et al (2008) Prevalence of celiac disease in children with autoimmune hepatitis. Dig Liver Dis 40:965

    Article  PubMed  CAS  Google Scholar 

  93. George EK et al (1996) Juvenile chronic arthritis and coeliac disease in The Netherlands. Clin Exp Rheumatol 14(5):571–575

    PubMed  CAS  Google Scholar 

  94. Bonamico M et al (2002) Prevalence and clinical picture of celiac disease in Turner syndrome. J Clin Endocrinol Metab 87(12):5495–5498

    Article  PubMed  CAS  Google Scholar 

  95. Bonamico M et al (2001) Prevalence and clinical picture of celiac disease in Italian Down syndrome patients: a multicenter study. J Pediatr Gastroenterol Nutr 33(2):139–143

    Article  PubMed  CAS  Google Scholar 

  96. Ventura A, Magazzu G, Greco L (1999) Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Gastroenterology 117(2):297–303

    Article  PubMed  CAS  Google Scholar 

  97. Sategna Guidetti C et al (2001) Duration of gluten exposure in adult coeliac disease does not correlate with the risk for autoimmune disorders. Gut 49(4):502–505

    Article  PubMed  CAS  Google Scholar 

  98. Viljamaa M et al (2005) Coeliac disease, autoimmune diseases and gluten exposure. Scand J Gastroenterol 40(4):437–443

    Article  PubMed  CAS  Google Scholar 

  99. Cosnes J et al (2008) Incidence of autoimmune diseases in celiac disease: protective effect of the gluten-free diet. Clin Gastroenterol Hepatol 6:753–758

    Article  PubMed  Google Scholar 

  100. Metso S et al (2012) Gluten-free diet and autoimmune thyroiditis in patients with celiac disease. A prospective controlled study. Scand J Gastroenterol 47(1):43–48

    Article  PubMed  Google Scholar 

  101. Molteni N, Bardella MT, Bianchi PA (1990) Obstetric and gynecological problems in women with untreated celiac sprue. J Clin Gastroenterol 12(1):37–39

    Article  PubMed  CAS  Google Scholar 

  102. Sher KS, Mayberry JF (1994) Female fertility, obstetric and gynaecological history in coeliac disease. A case control study. Digestion 55(4):243–246

    Article  PubMed  CAS  Google Scholar 

  103. Stazi AV, Mantovani A (2000) A risk factor for female fertility and pregnancy: celiac disease. Gynecol Endocrinol 14(6):454–463

    Article  PubMed  CAS  Google Scholar 

  104. Baker PG, Read AE (1975) Reversible infertility in male coeliac patients. Br Med J 02(5966):316–317

    Article  CAS  Google Scholar 

  105. Choi JM et al (2011) Increased prevalence of celiac disease in patients with unexplained infertility in the United States. J Reprod Med 56(5–6):199–203

    PubMed  Google Scholar 

  106. Zugna D et al (2010) A nationwide population-based study to determine whether coeliac disease is associated with infertility. Gut 59(11):1471–1475

    Article  PubMed  Google Scholar 

  107. Ludvigsson JF, et al. (2012) The Oslo definitions for coeliac disease and related terms. Gut. doi:10.1136/gutjnl-2011-301346

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Authors and Affiliations

  1. Department of Pediatrics, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Norelle Rizkalla Reilly

  2. Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Peter H. R. Green

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  1. Norelle Rizkalla Reilly
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  2. Peter H. R. Green
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Correspondence to Peter H. R. Green.

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This article is published as part of the Special Issue on Celiac Disease [34:6].

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Reilly, N.R., Green, P.H.R. Epidemiology and clinical presentations of celiac disease. Semin Immunopathol 34, 473–478 (2012). https://doi.org/10.1007/s00281-012-0311-2

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