[The global village of celiac disease]

Recent data suggest that celiac disease, or gluten-sensitive enteropathy, is a common disorder not only in populations of European ancestry, but also in developing areas, such as North Africa, Middle East and India. The world distribution of celiac disease apparently relates to the consumption of gluten-containing cereals. In the Arab people of Saharawi, the prevalence of celiac disease in children is so high (more than 5%) that this condition represents a primary health problem. In developing countries the clinical picture of celiac disease is often typical, characterized by chronic diarrhea, malnutrition, stunting and increased mortality, especially in younger children. The high prevalence of celiac disease in areas showing a poor sanitary condition could be explained by a protective role of the celiac enteropathy (against intestinal infections) in the context of a low gluten consumption. The problem of celiac disease in developing countries should by approached by a multifaceted strategy, based on (1) increasing disease awareness and diagnostic facilities and (2) a "flexible" dietary intervention that takes into account the nutritional habits and local food availability.