The prevalence of celiac disease in at-risk groups of children in the United States,☆☆,

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Abstract

Objective: In contrast to its prevalence in Europe, celiac disease (CD) is considered rare in the United States. We aimed to determine the prevalence of CD in children presenting with symptoms or conditions associated with CD. Study design: Individuals aged 6 months to 20 years were screened for IgG and IgA antigliadin (AGA-IgG and AGA-IgA) and antiendomysium (EMA) antibodies. Those with only elevated AGA-IgG were screened for selective IgA deficiency. Patients with elevated EMA, or AGA-IgG elevation and selective IgA deficiency, were advised to undergo small intestinal biopsy. Results: A total of 1200 individuals were studied; 34 were EMA positive—26 (19 EMA positive) consented to biopsy and 21 had CD, giving a prevalence of 1 in 57 (21/1200). Including the 15 EMA positive patients who refused a biopsy, the prevalence of CD in this study could be as high as 1 in 33 (36/1200). Conclusions: CD is not rare in the United States and may be as common as in Europe. AGA and EMA are useful for identifying patients who should undergo a small intestinal biopsy. (J Pediatr 2000;136:86-90)

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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).

. Results of serologic tests for CD

GroupNEMAIgG/AGA onlyIgA/AGA onlyIgG + IgA AGA
Abdominal pain31644217
Diabetes8132411
Chronic diarrhea18273803
Failure to thrive12383235
Short stature25924360
Relatives19292713
Miscellaneous*4711002
Total1200342161221
*Miscellaneous group includes Down syndrome (10), anemia (6), vomiting (20), elevated liver enzymes (5), abdominal distention (2), and aphthous ulcers (4).
Approximately 1 in every 35 (34/1200)

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.

☆☆

Reprint requests: Ivor Hill, MB,ChB, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157.

0022-3476/2000/$12.00 +0  9/21/102939

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