Population screening for coeliac disease in a low prevalence area in Italy

Giorgio Menardo, Renata Brizzolara, Stefano Bonassi, Alessandro Marchetti, Gian Luigi Dante, Cristina Pistone, Donatella Marenco, Viviana Rabellino, Sandra Buscaglia, Rita Scarso, Mauro Murialdo, Ezio Venturino, Carla Enrica Marino, Desideria Descalzi, Franca Minetti, Marcello Bagnasco, Giampaola Pesce

Research output: Contribution to journalArticle

Abstract

Objective. A screening program was proposed for the village of Carcare (population 5700), located in a region of Italy with an apparently low prevalence of coeliac disease (CD): only 1 patient diagnosed out of 2557 inhabitants. The study group comprised 1002 individuals (568 F, 434 M, age range 13-90 years) recruited from blood donors, secondary school pupils and people referred to the local outpatient facilities for routine blood chemistry. Material and methods. Total IgA, IgA anti-tissue transglutaminase (tTG) (ELISA, recombinant human antigen) and IgA antiendomysium (EMA) (IFI, umbilical cord substrate) antibodies were measured in the serum of all participants. All patients with IgA deficiency were investigated for IgG tTG antibodies, and in the case of disagreement between tTG and EMA, they were typed for HLA DQ2-DQ8 haplotypes. Results. Thirteen subjects were positive and 988 negative for autoantibodies (3/988 had IgA deficiency). One serum sample was positive for tTG antibodies but negative for EMA. Ten out of 13 positive subjects consented to undergo duodenal biopsy, which invariably produced evidence of CD despite the absence of clinical signs/symptoms. A post-diagnostic clinical investigation provided evidence showing mild iron deficiency (4 subjects) and osteoporosis (2 subjects). After counselling, all subjects accepted a gluten-free diet. Conclusions. The prevalence of CD in the study group was 1:100 (1.0%; 95% CI: 0.5-1.8%): this indicates that CD is largely underdiagnosed in Carcare. Our results suggest that the low prevalence of CD observed in some regions is likely to be due to underdiagnosis.

Original languageEnglish
Pages (from-to)1414-1420
Number of pages7
JournalScandinavian Journal of Gastroenterology
Volume41
Issue number12
DOIs
Publication statusPublished - Dec 1 2006

Keywords

  • Coeliac disease
  • Gluten-free diet
  • HLA DQ2-DQ8 haplotypes
  • IgA anti-tissue transglutaminase (tTG)
  • IgA antiendomysium (EMA)
  • Screening study

ASJC Scopus subject areas

  • Gastroenterology

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    Menardo, G., Brizzolara, R., Bonassi, S., Marchetti, A., Dante, G. L., Pistone, C., Marenco, D., Rabellino, V., Buscaglia, S., Scarso, R., Murialdo, M., Venturino, E., Marino, C. E., Descalzi, D., Minetti, F., Bagnasco, M., & Pesce, G. (2006). Population screening for coeliac disease in a low prevalence area in Italy. Scandinavian Journal of Gastroenterology, 41(12), 1414-1420. https://doi.org/10.1080/00365520600815605