Related Experiment Video
Updated: Feb 25, 2026
A High-Throughput Multiplexed Screening for Type 1 Diabetes, Celiac Diseases, and COVID-19
Published on: July 5, 2022
Mass Screening for Celiac Disease Among School-aged Children: Toward Exploring Celiac Iceberg in Saudi Arabia
Abdulrahman Al-Hussaini1, Riccardo Troncone2, Musa Khormi3
1Division of Pediatric Gastroenterology, Children's Specialized Hospital, King Fahad Medical City, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
Insights
Celiac disease (CD) affects 1.5% of Saudi children, a prevalence twice that of Europe. This mass screening identified silent, mild symptomatic, and growth-impaired forms of CD in Riyadh
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Public Health
Background:
- Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion.
- The prevalence and clinical spectrum of CD in the pediatric population of Saudi Arabia remain undercharacterized.
- Understanding the 'celiac iceberg' is crucial for early diagnosis and management.
Purpose of the Study:
- To determine the prevalence of celiac disease (CD) in Saudi children residing in Riyadh.
- To characterize the clinical presentation and spectrum of the 'celiac iceberg' within this population.
- To provide epidemiological data on CD in the Middle East.
Main Methods:
- A cross-sectional, mass screening study involving 7930 Saudi primary and intermediate school students in Riyadh.
- Immunoglobulin A-tissue transglutaminase (TTG-IgA) antibody testing was the primary screening tool.
- Positive and borderline results were confirmed with repeat testing, IgA-endomyseal antibody (EMA-IgA), upper endoscopy, and intestinal biopsies.
Main Results:
- A total of 221 students (2.8%) had positive TTG-IgA results.
- Celiac disease was diagnosed in 119 children (1.5% prevalence, or 1:67), with a mean age of 11.5 years and 68% being girls.
- Identified clinical patterns included silent CD (37%), mild symptomatic (48%), and symptomatic with impaired growth (15%).
Conclusions:
- The prevalence of celiac disease among Saudi children in Riyadh is high at 1.5%.
- This prevalence is approximately double the average rates reported in Europe and North America.
- The study highlights the significant burden of CD and its varied clinical manifestations in the Saudi pediatric population.
Objectives:
We conducted this mass screening study to determine the prevalence of celiac disease (CD) and characterize the celiac iceberg among Saudi pediatric population in Riyadh, the capital city of Saudi Arabia.
Methods:
During the study period (January 2014-June 2016), we have conducted a cross-sectional, mass screening, immunoglobulin A-tissue transglutaminase (TTG-IgA)-based study on 7930 Saudi students from primary and intermediate schools in Riyadh. Students with positive TTG-IgA (>20 U/L) were called in the hospital to undergo a repeat of TTG-IgA; in those with borderline positive TTG-IgA (20-60 U/L), IgA-endomyseal antibody (EMA-IgA) test was performed. Children with TTG-IgA >60 U/L and children with borderline positive TTG-IgA and positive EMA-IgA were advised to undergo upper endoscopy and intestinal biopsies.
Results:
We identified 221 students with positive TTG-IgA (2.8%). CD was diagnosed in 119 cases (1.5%, 1:67 Saudi children) (mean age 11.5 ± 2.62 years; girls 81 [68%]). Another 51 children had persistently borderline positive TTG-IgA but negative EMA (0.64%) and the remaining 51 had transiently positive TTG-IgA. We have identified 3 clinical patterns in the screening-identified cases with CD: a silent form (37%), a mild symptomatic form characterized by gastrointestinal symptoms in presence of normal growth or overweight/obesity (48%), and gastrointestinal symptoms associated with impaired growth in 15%.
Conclusions:
Our study provided evidence of a high prevalence of CD among Saudi children (1.5%), a rate that is at least twice the average prevalence rate in Europe and North America.
