Celiac disease in the Mediterranean area

Area of Science:

• Gastroenterology and Pediatric Medicine
• Celiac Disease Diagnostics
• Public Health Epidemiology

Background:

• The World Gastroenterology Organization advocates for national Celiac Disease (CD) diagnostic guidelines.
• A comprehensive understanding of CD diagnosis across countries is essential.
• This study focuses on the Mediterranean basin, an area with an emerging CD epidemic.

Purpose of the Study:

• To profile clinical features and diagnostic capabilities for Celiac Disease (CD) in 16 Mediterranean countries.
• To assess the applicability of the new European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) protocol for diagnosing CD without small intestinal biopsy.

Main Methods:

• A stratified, cross-sectional, retrospective study design was employed.
• Clinical, histological, and laboratory data were analyzed from 749 children diagnosed with Celiac Disease (CD) at national referral centers.

Main Results:

• The majority of Celiac Disease (CD) cases were diagnosed before age 10, often presenting with diarrhea and weight loss.
• Tissue transglutaminase (tTG) assay availability was limited by financial constraints in one-third of centers; endomysial antibodies and HLA typing were less accessible.
• Only 20.5% of cases would meet criteria for a biopsy-less Celiac Disease (CD) diagnosis under the new ESPGHAN protocol.

Conclusions:

• Capacities for diagnosing the emerging Celiac Disease (CD) epidemic in the Mediterranean region present a complex picture.
• Findings support the World Gastroenterology Organization's call for standardized national diagnostic guidelines.
• The study highlights significant barriers to implementing newer, potentially biopsy-sparing, diagnostic protocols in the region.