The prevalence of celiac disease in at-risk groups of children in the United States☆,☆☆,★
Section snippets
PATIENTS
Children between 6 months and 20 years of age presenting to the pediatric gastroenterology or pediatric endocrinology clinics of the Wake Forest University School of Medicine and the University of Maryland School of Medicine were considered for the study. The institutional review boards of both institutions approved the study and informed consent was obtained from all participants. The patients were assigned to 1 of 7 groups according to their initial symptoms.
Group 1: chronic diarrhea (defined
METHODS
Blood was obtained by venipuncture for determination of IgG and IgA antigliadin antibodies and antiendomysium antibodies. AGA was determined by an enzymatic immunoassay (Eurospital, Trieste, Italy). IgA-EMA was determined by means of indirect immunofluorescence with cryosections of monkey esophagus as substrate (Scimdx, Denville, NJ).
Patients with positive EMA test results were advised to undergo small intestinal biopsy for definitive diagnosis. Those who were positive for AGA-IgG antibodies
RESULTS
A total of 1200 patients were included in the study (Table I).Group N EMA IgG/AGA only IgA/AGA only IgG + IgA AGA Abdominal pain 316 4 42 1 7 Diabetes 81 3 24 1 1 Chronic diarrhea 182 7 38 0 3 Failure to thrive 123 8 32 3 5 Short stature 259 2 43 6 0 Relatives 192 9 27 1 3 Miscellaneous* 47 1 10 0 2 Total 1200 34 216 12 21 *Miscellaneous group includes Down syndrome (10), anemia (6), vomiting (20), elevated liver enzymes (5), abdominal distention (2), and aphthous ulcers (4).
DISCUSSION
Studies in Europe suggest CD may occur in as many as 1:250 of the population.1, 2, 3, 4, 5, 6, 7 Many patients in one study were free of symptoms at the time of diagnosis and were identified only through use of serologic screening tests.2 In contrast, the prevalence of CD in the United States is estimated by Talley et al10 and by Rossi, Albini, and Kumar11 to be 1:4857 and 1:5464, respectively. By design, these studies excluded all those without symptoms and many with mild symptoms or
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Supported in part by a grant awarded to Ivor Hill, MD, by the American College of Gastroenterology and an internal grant awarded to Karoly Horvath, MD, by the University of Maryland School of Medicine.
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Reprint requests: Ivor Hill, MB,ChB, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157.
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0022-3476/2000/$12.00 +0 9/21/102939