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Celiac disease in the Mediterranean area
Francesca Tucci, Luca Astarita, Abdelhak Abkari
1European Laboratory for Food Induced Diseases, University of Naples Federico II, Naples 80131, Italy. ydongre@unina.it.
Insights
Diagnosis of Celiac Disease (CD) in the Mediterranean is challenging, with many centers lacking resources for antibody testing. Most pediatric CD cases require small intestinal biopsy for diagnosis, even with new guidelines.
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.
Background:
The World Gastroenterology Organization recommends developing national guidelines for the diagnosis of Celiac Disease (CD): hence a profile of the diagnosis of CD in each country is required. We aim to describe a cross-sectional picture of the clinical features and diagnostic facilities in 16 countries of the Mediterranean basin. Since a new ESPGHAN diagnostic protocol was recently published, our secondary aim is to estimate how many cases in the same area could be identified without a small intestinal biopsy.
Methods:
By a stratified cross-sectional retrospective study design, we examined clinical, histological and laboratory data from 749 consecutive unselected CD children diagnosed by national referral centers.
Results:
The vast majority of cases were diagnosed before the age of 10 (median: 5 years), affected by diarrhea, weight loss and food refusal, as expected. Only 59 cases (7.8%) did not suffer of major complaints. Tissue transglutaminase (tTG) assay was available, but one-third of centers reported financial constraints in the regular purchase of the assay kits. 252 cases (33.6%) showed tTG values over 10 times the local normal limit. Endomysial antibodies and HLA typing were routinely available in only half of the centers. CD was mainly diagnosed from small intestinal biopsy, available in all centers. Based on these data, only 154/749 cases (20.5%) would have qualified for a diagnosis of CD without a small intestinal biopsy, according to the new ESPGHAN protocol.
Conclusions:
This cross-sectional study of CD in the Mediterranean referral centers offers a puzzling picture of the capacities to deal with the emerging epidemic of CD in the area, giving a substantive support to the World Gastroenterology Organization guidelines.
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