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Prevalence of Serologically Defined Celiac Disease in Patients With Irritable Bowel Syndrome in Asia: A Multicountry
Anam Ahmed1,2, Ashish Chauhan1,3, Alka Kumari1,4
1Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Insights
Celiac disease (CeD) affects 2.75% of Asian patients with irritable bowel syndrome (IBS). Screening is crucial, as prevalence varies by country and patient factors, highlighting the need for increased awareness of CeD in Asia.
Area of Science:
- Gastroenterology
- Immunology
- Public Health
Background:
- Celiac disease (CeD) is underdiagnosed in Asian populations.
- Irritable bowel syndrome (IBS) shares symptoms with CeD, leading to potential misdiagnosis.
Purpose of the Study:
- To determine the prevalence of CeD in Asian IBS patients.
- To identify risk factors for CeD in this population to guide screening efforts.
Main Methods:
- A two-step serological screening (IgA anti-tissue transglutaminase antibody and IgA deamidated gliadin-peptide antibodies) was used in 2546 IBS patients across six Asian countries.
- A Boruta algorithm identified predictors for CeD, and a nomogram was developed for risk prediction.
- Duodenal biopsies confirmed CeD in a subset of patients with positive serology.
Main Results:
- The overall prevalence of serologically defined CeD was 2.75%, with significant variation across countries (highest in Malaysia, India, Indonesia; lowest in Japan).
- Predictors for CeD risk included country, hemoglobin levels, age, sex, and diarrhea.
- High antibody titers (IgA anti-tTG-Ab >10-fold above normal) were observed in 0.71% of IBS patients.
Conclusions:
- A significant prevalence of CeD exists in Asian IBS patients, necessitating improved diagnostic awareness.
- The developed nomogram can aid in identifying high-risk individuals for targeted CeD screening.
- Further research is recommended to understand the full scope of CeD across Asia.
Background And Aim:
Celiac disease (CeD) is not adequately recognized in Asia. We aimed to assess the prevalence of CeD in patients with irritable bowel syndrome (IBS) in six Asian countries and identify high-risk groups meriting screening.
Methods:
Patients with IBS (Rome III) were recruited from Japan, Thailand, Indonesia, Malaysia, Singapore, and India. A two-step noninvasive strategy was used [positive IgA anti-tissue transglutaminase antibody (IgA anti-tTG-Ab) followed by confirmation with IgA deamidated gliadin-peptide antibodies (anti-DGP-Ab)]. Consenting patients with positive serology also underwent duodenal biopsies. Positivity for both IgA-anti-tTG-Ab and IgA-anti-DGP-Ab was labeled as serologically defined CeD. Important predictors of CeD were identified using the Boruta algorithm, and a nomogram for predicting CeD was constructed.
Results:
2546 patients with IBS were evaluated across 6 countries. Overall prevalence serologically defined CeD (positive for both IgA anti-tTG Ab and IgA anti-DGP antibodies) was 2.75% (n = 70; 95% CI, 2.11%-3.39%). Prevalence was highest in Malaysia (3.8%), India (3.75%), and Indonesia (3.61%) and lowest in Japan (0.1%). Duodenal biopsies were performed in 20 patients, and 14 of them showed villous abnormalities (modified Marsh grade 2 or more). Among IgA anti-tTG-Ab-positive patients (n = 204; 8.01% 95% CI, 6.96%-9.07%), 18 (0.71%), 21 (0.82%), and 165 (6.48%) exhibited anti-tTG-Ab titer more than 10-fold, 6-10-fold, and 1-5-fold above the upper limit of normal. We propose a nomogram to predict the risk of CeD in Asian patients with IBS based on country, hemoglobin, age, sex, and diarrhea.
Conclusion:
Overall prevalence of serologically defined CeD in Asian patients with IBS is 2.75% but differs across patient profiles. This study suggests the need for better awareness and further studies on the prevalence of CeD across Asia.
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