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Prevalence of celiac disease among dyspeptic patients: a community-based case-control study
Engin Altintaş1, Mehmet S Senli, Orhan Sezgin
1Department of Gastroenterology, Mersin University, School of Medicine, Mersin, Turkey. enginaltintas@mersin.edu.tr
Background/Aims:
To determine the relation between undiagnosed celiac disease and dyspepsia in the community.
Methods:
Patients presenting to the gastroenterology outpatient clinic of Mersin University Hospital, aged between 18 and 70 years and with no malignancy, malabsorption, chronic diarrhea, inflammatory bowel disease, diabetes mellitus, heart failure or renal failure, were asked to complete a questionnaire for functional bowel disease (based on Rome II criteria for irritable bowel syndrome and dyspepsia). The patients diagnosed with dyspepsia based on Rome II criteria formed the dyspepsia group and those with gastrointestinal complaints other than dyspepsia and irritable bowel syndrome formed the control group. Serum tissue transglutaminase antibody (anti-tTG) was determined in all patients. The patients with anti-tTG levels of >20U/ml underwent endoscopic duodenal biopsy.
Results:
The study included a total of 137 patients, of whom 69 (50.4%) were assigned into the dyspepsia group and 68 (49.6%) into the control group. Of 137 patients, 24 (17.5%) had an anti-tTG level of > or =20U/ml: 14 in the dyspepsia group (20.3%) and 10 in the control group (14.7%), with no significant difference between the groups (p=0.39). Of the 24 patients positive for anti-tTG, 15 (64.5%) underwent endoscopy, and of these 15 patients, 8 (53.3%) had endoscopic duodenal biopsy. Biopsy revealed that of the 4 patients in the dyspepsia group, 3 (75%) had Marsh type 0 histology (IEL<40, normal crypt) and 1 (25%) had Marsh type 3a histology. Of the 4 patients in the control group, 3 (75%) had Marsh type 0 histology and 1 (25%) had Marsh type 3a histology. Histopathological examinations showed celiac disease in 2 out of the 8 patients (25%) positive for anti-tTG who underwent biopsy. Intention to treat analyses revealed that 1 of 69 patients in the dyspepsia group (1.44%) and 1 of 68 patients in the control group (1.47%) had celiac disease.
Conclusions:
Celiac disease in this patient population had a high prevalence. Further studies with larger sample sizes are needed to confirm the relation between dyspepsia and celiac disease.
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