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Where have all the American celiacs gone?
1Division of Pediatric Gastroenterology and Nutrition, University of Maryland, School of Medicine, Baltimore 21201, USA.
Summary
Celiac disease may be as common in the USA as in Europe, but it is significantly underdiagnosed. Further large-scale studies are needed to confirm the prevalence of celiac disease in the United States.
Area of Science:
- Gastroenterology
- Epidemiology
- Immunology
Background:
- Celiac disease is a prevalent cause of malabsorption in Western countries.
- Recent European studies indicate a homogeneous distribution and higher incidence than previously thought.
- Clinical presentations vary significantly, even regionally.
Purpose of the Study:
- To investigate the prevalence of celiac disease in the United States.
- To compare US celiac disease prevalence with European data.
- To assess whether celiac disease is underdiagnosed in the US.
Main Methods:
- Preliminary serological screening studies were conducted.
- Studies included both pediatric patients and adult blood donors.
- Data were compared with similar European screening studies.
Main Results:
- Preliminary US data suggest a prevalence of positive screening tests equivalent to European levels.
- The "iceberg" dimensions for celiac disease in the US appear similar to Europe.
- The diagnosed portion of the US celiac disease "iceberg" is significantly smaller, indicating underdiagnosis.
Conclusions:
- Celiac disease may be as prevalent in the US as in Europe.
- The disease is likely underdiagnosed in the United States.
- Large, multicenter serological screening studies are required to determine the true prevalence.