The prevalence of celiac disease in average-risk and at-risk Western European populations: A systematic review

https://doi.org/10.1053/j.gastro.2005.02.014Get rights and content

Until recently, celiac disease (CD) was felt to be a rare disease in the United States. The aim of this study was to conduct a systematic review of the prevalence of CD in general Western populations and in populations at high risk for CD. Standard systematic review methodology was used. A literature search was conducted in MEDLINE (1966 to October 2003) and EMBASE (1974 to December 2003) databases. Qualitative and quantitative prevalence estimates were produced after assessing study heterogeneity. The prevalence of CD in general Western populations is close to 1% and is somewhat higher in certain Western European populations. The prevalence of CD in populations at risk for CD is as follows: 3%–6% in type 1 diabetic patients, up to 20% in first-degree relatives, 10%–15% in symptomatic iron-deficiency anemia (IDA), 3%–6% in asymptomatic IDA, and 1%–3% in osteoporosis. The prevalence of CD in patients suspected of having CD varied depending on the reasons for suspecting CD and on whether the study was conducted in a referral center. In general, the prevalence ranged from 5% to 15%, but was up to 50% in symptomatic patients evaluated in a tertiary referral center. CD is a common medical condition. The prevalence is higher still in high-risk groups. Clinicians in a variety of specialties should have a high index of suspicion for the diagnosis of CD and in particular need to pay close attention to the identified high-risk groups.

Section snippets

Methods

This article represents a portion of a multipart systematic review conducted for the Agency for Healthcare Research and Quality. A comprehensive literature search was conducted by the National Library of Medicine in collaboration with the University of Ottawa Evidence Based Practice Center. The searches were run in MEDLINE (1966 to October 2003) and EMBASE (1974 to December 2003) databases.

Study selection was performed by 2 independent reviewers using 3 levels of screening. Articles passing the

Results

The literature search yielded 2116 references. A total of 133 publications were included in the review. Of these, 14 publications were identified as duplicates on the basis that the same study population was reported on elsewhere, or as part of a larger cohort.4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17

Prevalence in the general population: different geographic and racial/ethnic populations

The included prevalence studies showed important differences in execution, tests for prevalence assessment, and in patient sampling, making pooled estimates of prevalence potentially unreliable. Furthermore, the influence of disease prevalence on the positive and negative predictive values of these tests, and the criteria by which clinical and histologic CD is defined, have to be kept in mind when considering the results of this report. The last point regarding the histologic definition of CD

References (129)

  • G. Corazza et al.

    Gliadin immune reactivity is associated with overt and latent enteropathy in relatives of celiac patients

    Gastroenterology

    (1992)
  • A. Fasano et al.

    Prevalence of celiac disease in at-risk and not-at-risk groups in the United Statesa large multicenter study

    Arch Intern Med

    (2003)
  • A. Tommasini et al.

    Mass screening for coeliac disease using antihuman transglutaminase antibody assay

    Arch Dis Child

    (2004)
  • Ophthalmology Study Design Worksheet #3. Noncomparative (nonrandomized, noncontrolled) Interventional Case Series....
  • C. Catassi et al.

    High prevalence of undiagnosed coeliac disease in 5280 Italian students screened by antigliadin antibodies

    Acta Paediatr

    (1995)
  • E. Grodzinsky et al.

    Presence of IgA and IgG antigliadin antibodies in healthy adults as measured by micro-ELISAEffect of various cutoff levels on specificity and sensitivity when diagnosing coeliac disease

    Int Arch Allergy Immunol

    (1990)
  • E. Grodzinsky et al.

    High prevalence of celiac disease in healthy adults revealed by antigliadin antibodies

    Ann Allergy

    (1992)
  • C. Lagerqvist et al.

    Screening for adult coeliac disease—which serological marker(s) to use?

    J Intern Med

    (2001)
  • B. Weile et al.

    Screening Danish blood donors for antigliadin and antiendomysium antibodies

    Acta Paediatr

    (1996)
  • S.A. McMillan et al.

    Factors associated with serum antibodies to reticulin, endomysium, and gliadin in an adult population

    Gut

    (1996)
  • L. Stenhammar et al.

    A family study of coeliac disease

    Acta Paediatr Scand

    (1982)
  • K. Holm et al.

    Immunohistochemical changes in the jejunum in first degree relatives of patients with coeliac disease and the coeliac disease marker DQ genes. HLA class II antigen expression, interleukin-2 receptor positive cells and dividing crypt cells

    Gut

    (1994)
  • K. Sjoberg et al.

    Gliadin antibodies in adult insulin-dependent diabetes—autoimmune and immunogenetic correlates

    Autoimmunity

    (2000)
  • A.K. Carlsson et al.

    Prevalence of IgA-antiendomysium and IgA-antigliadin autoantibodies at diagnosis of insulin-dependent diabetes mellitus in Swedish children and adolescents

    Pediatrics

    (1999)
  • A. Ivarsson et al.

    Epidemic of coeliac disease in Swedish children

    Acta Paediatr

    (2000)
  • M. Maki et al.

    Incidence and prevalence of coeliac disease in Tampere. Coeliac disease is not disappearing

    Acta Paediatr Scand

    (1990)
  • T. Not et al.

    Celiac disease risk in the USAhigh prevalence of antiendomysium antibodies in healthy blood donors

    Scand J Gastroenterol

    (1998)
  • A.K. Carlsson et al.

    Serological screening for celiac disease in healthy 2.5-year-old children in Sweden

    Pediatrics

    (2001)
  • P. Collin et al.

    The hunt for coeliac disease in primary care

    QJM

    (2002)
  • E. Grodzinsky

    Screening for coeliac disease in apparently healthy blood donors

    Acta Paediatr

    (1996)
  • N. Hovdenak et al.

    High prevalence of asymptomatic coeliac disease in Norwaya study of blood donors

    Eur J Gastroenterol Hepatol

    (1999)
  • A. Ivarsson et al.

    High prevalence of undiagnosed coeliac disease in adultsa Swedish population-based study

    J Intern Med

    (1999)
  • K.L. Kolho et al.

    Undiagnosed coeliac disease is common in Finnish adults

    Scand J Gastroenterol

    (1998)
  • M. Maki et al.

    Prevalence of celiac disease among children in Finland

    N Engl J Med

    (2003)
  • K. Sjoberg et al.

    Prevalence and clinical significance of gliadin antibodies in healthy children and adults

    Scand J Gastroenterol

    (1994)
  • K. Sjoberg et al.

    Regional differences in coeliac disease prevalence in Scandinavia?

    Scand J Gastroenterol

    (1999)
  • I. Weile et al.

    High prevalence rates of adult silent coeliac disease, as seen in Sweden, must be expected in Denmark

    APMIS

    (2001)
  • K. Borch et al.

    Prevalence of coeliac disease and relations to Helicobacter pylori infection and duodenitis in a Swedish adult population samplea histomorphological and serological survey

    Inflammopharmacology

    (2000)
  • C. Catassi et al.

    The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school-age subjects

    Acta Paediatr

    (1996)
  • C. Catassi et al.

    Antiendomysium versus antigliadin antibodies in screening the general population for coeliac disease

    Scand J Gastroenterol

    (2000)
  • D.P. Mazzetti et al.

    Subclinical coeliac disease

    Ital J Gastroenterol

    (1992)
  • K. Pittschieler et al.

    Coeliac diseasescreened by a new strategy

    Acta Paediatr

    (1996)
  • C. Trevisiol et al.

    Screening for coeliac disease in healthy blood donors at two immuno-transfusion centres in north-east Italy

    Ital J Gastroenterol Hepatol

    (1999)
  • U. Volta et al.

    High prevalence of celiac disease in Italian general population

    Dig Dis Sci

    (2001)
  • S.D. Johnston et al.

    Coeliac disease detected by screening is not silent—simply unrecognized

    QJM

    (1998)
  • D.S. Sanders et al.

    A primary care cross-sectional study of undiagnosed adult coeliac disease

    Eur J Gastroenterol Hepatol

    (2003)
  • J. West et al.

    Seroprevalence, correlates, and characteristics of undetected coeliac disease in England

    Gut

    (2003)
  • W. Dickey et al.

    Antigliadin antibodies in blood donors in Northern Ireland

    Eur J Gastroenterol Hepatol

    (1992)
  • S. Riestra et al.

    Prevalence of coeliac disease in the general population of northern Spain. Strategies of serologic screening

    Scand J Gastroenterol

    (2000)
  • G.R. Corazza et al.

    The smaller size of the ‘coeliac iceberg’ in adults

    Scand J Gastroenterol

    (1997)
  • Cited by (543)

    • Making a Confident Diagnosis of Irritable Bowel Syndrome

      2021, Gastroenterology Clinics of North America
    • Pediatric gastrointestinal disorders: An overview

      2023, Chronic Disease and Disability: The Pediatric Gastrointestinal Tract, Second Edition. Overview with Perspectives of History, Nutrition and Behavioral Pediatrics
    View all citing articles on Scopus
    View full text