Prevalence of occult celiac disease in healthy Iranian school age children
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Published on: August 22, 2012
Fatemeh Farahmand1, Mohammad Mehdi Mir-Nasseri, Touran Shahraki
1Digestive Disease Research Center, Pediatric Unit, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Occult celiac disease (CD) was found in 0.5% of healthy Iranian school children, indicating a need for further research into treating asymptomatic cases. This study highlights the effectiveness of anti-tissue transglutaminase antibody screening in identifying hidden CD.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Public Health
Background:
- Celiac disease (CD) prevalence in Iran is approximately 1%, similar to global rates.
- Information on occult CD in healthy school-aged children in Iran is limited.
- This study addresses the gap by investigating occult CD in this demographic.
Purpose of the Study:
- To determine the prevalence of occult celiac disease in apparently healthy Iranian school-aged children.
- To assess the utility of serological screening for identifying asymptomatic CD cases.
Main Methods:
- Cross-sectional screening of 634 healthy school children using serum IgA and IgA anti-tissue transglutaminase antibody (tTG) tests.
- Positive tTG results were rechecked, followed by endoscopic duodenal biopsies.
- Biopsy samples were analyzed using the Marsh classification.
Main Results:
- Three out of 634 children (0.5%) were diagnosed with celiac disease.
- All diagnosed children were asymptomatic, with a mean age of 14.3 years and a 2:1 female-to-male ratio.
- Duodenal biopsies confirmed CD in these subjects, leading to gluten-free diet recommendations.
Conclusions:
- The prevalence of occult CD in this cohort is 0.5%, half that of Iranian adults.
- Anti-tTG antibody testing is a valuable tool for screening occult CD.
- The necessity of treating asymptomatic CD cases with a gluten-free diet requires further consideration.
Background:
Several studies have shown the prevalence of celiac disease (CD) to be around 1% in Iran, which is similar to the worldwide prevalence. There is scant information on occult CD in apparently healthy school age children. This study, as the first such study in Iran, aims to determine the prevalence of occult CD in healthy Iranian school age children.
Methods:
In this cross-sectional study, we screened healthy school age children for CD by serum IgA and IgA anti-tissue transglutaminase antibody (tTG) levels. Measurement of these antibodies was by enzyme linked immunosorbent assay. A recheck of positive tTG tests was performed and patients who tested positive underwent endoscopic duodenal biopsies. The biopsy samples were scored according to the Marsh classification by an experienced pathologist.
Results:
A total of 634 children (314 males, 320 females; mean age: 12.8 years) were included in the study. All children and/or their parents completed a questionnaire and children underwent an initial physical examination to determine study eligibility. Positive serum tTG was noted in 3 (0.5%; 2 females) out of 634 patients. Duodenal biopsies were consistent with CD in these 3 subjects. The mean age of patients with CD was 14.3 years (range: 12-17 years). The female to male ratio was 2:1. These cases had no signs and symptoms, but a gluten-free diet was recommended according to pathologic changes in their small bowels and results of the tTG test.
Conclusion:
The prevalence of occult CD in these children is 0.5%, which is half of the prevalence of CD in Iranian adults. The anti-tTG concentration at initial serological CD screening is highly informative in determining occult cases of CD. The question is whether all non-symptomatic cases should be treated with a gluten-free diet or not.
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