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Rising prevalence of celiac disease is not universal and repeated testing is needed for population screening
Rachel Levinson-Castiel1, Rami Eliakim2,3, Eilat Shinar4
1Schneider Children's Medical Center, Institute for Gastroenterology, Nutrition and Liver Diseases, Petach Tikva, Israel.
Insights
The prevalence of celiac disease in Israeli blood donors has remained stable, indicating increased diagnoses are due to higher awareness, not a true rise in disease. Repeated antibody testing is crucial for screening asymptomatic individuals.
Area of Science:
- Immunology
- Gastroenterology
- Public Health
Background:
- Growing concerns regarding the increasing prevalence of celiac disease globally.
- Previous research established baseline celiac disease prevalence in healthy Israeli blood donors in 2002.
Purpose of the Study:
- To investigate changes in celiac disease and celiac disease autoimmunity prevalence over time.
- To compare current prevalence with historical data from 2002.
Main Methods:
- Prospective study involving 1908 healthy blood donors.
- Screening for tissue transglutaminase (tTG) antibodies and anti-endomysial antibodies (EMA).
- Diagnosis of celiac disease based on established criteria.
Main Results:
- Prevalence of celiac disease autoimmunity was 1.68% and celiac disease was 0.21%.
- Most elevated tTG antibodies (<3x ULN) were transient, with negative repeat tests and negative EMA.
- Celiac disease was diagnosed in 4 donors.
Conclusions:
- Celiac disease prevalence in Israeli blood donors has not increased over 15 years.
- Increased diagnosed celiac disease likely stems from heightened awareness and improved screening.
- Repeated tTG antibody testing is recommended for screening asymptomatic populations to reduce false positives.
Background:
Recent studies suggest that the prevalence of celiac disease is rising. We previously established the prevalence of celiac disease in healthy blood donors in 2002.
Objective:
The purpose of this study was to examine whether the prevalence of celiac disease and celiac disease autoimmunity has changed over time by performing a similar prospective study.
Methods:
Healthy blood donors (n = 1908) were tested for tissue transglutaminase antibodies and for anti-endomysial antibodies when positive. Further evaluation followed accepted criteria for diagnosis.
Results:
Overall, 32 donors had abnormal tissue transglutaminase antibodies (1.68%). Eight donors had tissue transglutaminase antibodies >3 × upper limit of normal (0.42%), two of them with tissue transglutaminase antibodies >10 × upper limit of normal, while 24 donors had tissue transglutaminase antibodies <3 × upper limit of normal (1.26%). Most of the donors with positive tissue transglutaminase antibodies <3 × upper limit of normal had negative tissue transglutaminase antibodies levels on repeated testing (18/19). Celiac disease was diagnosed in four donors with positive tissue transglutaminase antibodies, establishing a prevalence of 1.68% (95% confidence interval 1.15-2.3) for celiac disease autoimmunity and 0.21% for celiac disease (95% confidence interval 0.07-0.5%).
Conclusion:
The prevalence of celiac disease in blood donors in Israel did not rise in the last 15 years, suggesting that the increased prevalence of diagnosed celiac disease is mainly due to increased awareness. As most of the donors with elevated tissue transglutaminase antibodies <3 × upper limit of normal were endomysial antibody negative and had a negative tissue transglutaminase antibodies result upon re-testing, repeated tissue transglutaminase antibodies testing is required when screening asymptomatic populations for celiac disease.
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