While celiac disease prevalence varies geographically worldwide, frequency of the illness has increased in recent years, according to a study.
Researchers performed a systematic review of 266 studies collected from Medline and Embase assessing the worldwide prevalence of celiac disease (CD) in defined populations within geographical regions.
Across all evaluated age groups and time periods, incidence ranged from 0.9 cases per 100,000 person-years to 12.9, and from 1.27 to 39 per 100,000 person-years among adults alone. Prevalence rates were similarly varied: from 8.1 to 204 per 100,000 people across all age groups, from 4.7 to 250 per 100,000 children and from 45.9 to 550 per 100,000 adults. Regional variances in CD prevalence or incidence were attributed to differences in disease awareness, dietary intake, health care practices and socioeconomic factors.
Among 15 studies assessing CD prevalence via serological screening in unselected adult populations, prevalence ranged from 0% to 1.56% according to IgA EMA levels; 0% to 1.87% based on IgA tTG levels, and from 0.02% to 1.24% according to histology. Similarly varied results were observed across 17 studies assessing CD prevalence in children. Nearly all studies evaluating time trends for diagnoses of childhood CD indicated increased frequency in recent years, including serologically and clinically diagnosed cases.
Across all studies, 24 cases of Japanese or Chinese patients with CD were observed. Between 5% and 20% of Western Europeans had HLA DQ2 antigens associated with CD, compared with 5% to 10% of Chinese and sub-Saharan African patients. The DQ8 antigen was observed in 5% to 10% of English, Tunisian and Iranian patients, and in fewer than 5% of Americans, Asians and Eastern Europeans.
“The frequency of several GI diseases … increased rapidly in recent years, presumably through Westernization and urbanization,” the researchers wrote. “It is possible that the same will occur for CD, as Oriental populations possess the necessary HLA types and consume significant amounts of wheat. If even a tiny portion of Oriental and African individuals possessing DQ2 and DQ8 alleles were to develop CD, many cases would present in coming decades and lead to a significant public health problem.”