Prevalence of Celiac disease in at-risk and not-at-risk groups in the United States: A large multicenter study

Alessio Fasano, Irene Berti, Tania Gerarduzzi, Tarcisio Not, Richard B. Colletti, Sandro Drago, Yoram Elitsur, Peter H R Green, Stefano Guandalini, Ivor D. Hill, Michelle Pietzak, Alessandro Ventura, Mary Thorpe, Debbie Kryszak, Fabiola Fornaroli, Steven S. Wasserman, Joseph A. Murray, Karoly Horvath

Research output: Contribution to journalArticle

Abstract

Background: Celiac disease (CD) is an immunemediated enteropathic condition triggered in genetically susceptible individuals by the ingestion of gluten. Although common in Europe, CD is thought to be rare in the United States, where there are no large epidemiologic studies of its prevalence. The aim of this study was to determine the prevalence of CD in at-risk and not-atrisk groups in the United States. Methods: Serum antigliadin antibodies and antiendomysial antibodies (EMA) were measured. In EMA-positive subjects, human tissue transglutaminase IgA antibodies and CD-associated human leukocyte antigen DQ2/ DQ8 haplotypes were determined. Intestinal biopsy was recommended and performed whenever possible for all EMA-positive subjects. A total of 13 145 subjects were screened: 4508 first-degree and 1275 second-degree relatives of patients with biopsy-proven CD, 3236 symptomatic patients (with either gastrointestinal symptoms or a disorder associated with CD), and 4126 not-at-risk individuals. Results: In at-risk groups, the prevalence of CD was 1:22 in first-degree relatives, 1:39 in second-degree relatives, and 1:56 in symptomatic patients. The overall prevalence of CD in not-at-risk groups was 1:133. All the EMA-positive subjects who underwent intestinal biopsy had lesions consistent with CD. Conclusions: Our results suggest that CD occurs frequently not only in patients with gastrointestinal symptoms, but also in first- and second-degree relatives and patients with numerous common disorders even in the absence of gastrointestinal symptoms. The prevalence of CD in symptomatic patients and not-at-risk subjects was similar to that reported in Europe. Celiac disease appears to be a more common but neglected disorder than has generally been recognized in the United States.

Original languageEnglish
Pages (from-to)286-292
Number of pages7
JournalArchives of Internal Medicine
Volume163
Issue number3
DOIs
Publication statusPublished - Feb 10 2003

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Celiac Disease
Multicenter Studies
Biopsy
Antibodies
Glutens
HLA Antigens
Immunoglobulin A
Haplotypes
Epidemiologic Studies
Eating

ASJC Scopus subject areas

  • Internal Medicine

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Prevalence of Celiac disease in at-risk and not-at-risk groups in the United States : A large multicenter study. / Fasano, Alessio; Berti, Irene; Gerarduzzi, Tania; Not, Tarcisio; Colletti, Richard B.; Drago, Sandro; Elitsur, Yoram; Green, Peter H R; Guandalini, Stefano; Hill, Ivor D.; Pietzak, Michelle; Ventura, Alessandro; Thorpe, Mary; Kryszak, Debbie; Fornaroli, Fabiola; Wasserman, Steven S.; Murray, Joseph A.; Horvath, Karoly.

In: Archives of Internal Medicine, Vol. 163, No. 3, 10.02.2003, p. 286-292.

Research output: Contribution to journalArticle

Fasano, A, Berti, I, Gerarduzzi, T, Not, T, Colletti, RB, Drago, S, Elitsur, Y, Green, PHR, Guandalini, S, Hill, ID, Pietzak, M, Ventura, A, Thorpe, M, Kryszak, D, Fornaroli, F, Wasserman, SS, Murray, JA & Horvath, K 2003, 'Prevalence of Celiac disease in at-risk and not-at-risk groups in the United States: A large multicenter study', Archives of Internal Medicine, vol. 163, no. 3, pp. 286-292. https://doi.org/10.1001/archinte.163.3.286
Fasano, Alessio ; Berti, Irene ; Gerarduzzi, Tania ; Not, Tarcisio ; Colletti, Richard B. ; Drago, Sandro ; Elitsur, Yoram ; Green, Peter H R ; Guandalini, Stefano ; Hill, Ivor D. ; Pietzak, Michelle ; Ventura, Alessandro ; Thorpe, Mary ; Kryszak, Debbie ; Fornaroli, Fabiola ; Wasserman, Steven S. ; Murray, Joseph A. ; Horvath, Karoly. / Prevalence of Celiac disease in at-risk and not-at-risk groups in the United States : A large multicenter study. In: Archives of Internal Medicine. 2003 ; Vol. 163, No. 3. pp. 286-292.
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abstract = "Background: Celiac disease (CD) is an immunemediated enteropathic condition triggered in genetically susceptible individuals by the ingestion of gluten. Although common in Europe, CD is thought to be rare in the United States, where there are no large epidemiologic studies of its prevalence. The aim of this study was to determine the prevalence of CD in at-risk and not-atrisk groups in the United States. Methods: Serum antigliadin antibodies and antiendomysial antibodies (EMA) were measured. In EMA-positive subjects, human tissue transglutaminase IgA antibodies and CD-associated human leukocyte antigen DQ2/ DQ8 haplotypes were determined. Intestinal biopsy was recommended and performed whenever possible for all EMA-positive subjects. A total of 13 145 subjects were screened: 4508 first-degree and 1275 second-degree relatives of patients with biopsy-proven CD, 3236 symptomatic patients (with either gastrointestinal symptoms or a disorder associated with CD), and 4126 not-at-risk individuals. Results: In at-risk groups, the prevalence of CD was 1:22 in first-degree relatives, 1:39 in second-degree relatives, and 1:56 in symptomatic patients. The overall prevalence of CD in not-at-risk groups was 1:133. All the EMA-positive subjects who underwent intestinal biopsy had lesions consistent with CD. Conclusions: Our results suggest that CD occurs frequently not only in patients with gastrointestinal symptoms, but also in first- and second-degree relatives and patients with numerous common disorders even in the absence of gastrointestinal symptoms. The prevalence of CD in symptomatic patients and not-at-risk subjects was similar to that reported in Europe. Celiac disease appears to be a more common but neglected disorder than has generally been recognized in the United States.",
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AU - Fasano, Alessio

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AU - Gerarduzzi, Tania

AU - Not, Tarcisio

AU - Colletti, Richard B.

AU - Drago, Sandro

AU - Elitsur, Yoram

AU - Green, Peter H R

AU - Guandalini, Stefano

AU - Hill, Ivor D.

AU - Pietzak, Michelle

AU - Ventura, Alessandro

AU - Thorpe, Mary

AU - Kryszak, Debbie

AU - Fornaroli, Fabiola

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AU - Murray, Joseph A.

AU - Horvath, Karoly

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N2 - Background: Celiac disease (CD) is an immunemediated enteropathic condition triggered in genetically susceptible individuals by the ingestion of gluten. Although common in Europe, CD is thought to be rare in the United States, where there are no large epidemiologic studies of its prevalence. The aim of this study was to determine the prevalence of CD in at-risk and not-atrisk groups in the United States. Methods: Serum antigliadin antibodies and antiendomysial antibodies (EMA) were measured. In EMA-positive subjects, human tissue transglutaminase IgA antibodies and CD-associated human leukocyte antigen DQ2/ DQ8 haplotypes were determined. Intestinal biopsy was recommended and performed whenever possible for all EMA-positive subjects. A total of 13 145 subjects were screened: 4508 first-degree and 1275 second-degree relatives of patients with biopsy-proven CD, 3236 symptomatic patients (with either gastrointestinal symptoms or a disorder associated with CD), and 4126 not-at-risk individuals. Results: In at-risk groups, the prevalence of CD was 1:22 in first-degree relatives, 1:39 in second-degree relatives, and 1:56 in symptomatic patients. The overall prevalence of CD in not-at-risk groups was 1:133. All the EMA-positive subjects who underwent intestinal biopsy had lesions consistent with CD. Conclusions: Our results suggest that CD occurs frequently not only in patients with gastrointestinal symptoms, but also in first- and second-degree relatives and patients with numerous common disorders even in the absence of gastrointestinal symptoms. The prevalence of CD in symptomatic patients and not-at-risk subjects was similar to that reported in Europe. Celiac disease appears to be a more common but neglected disorder than has generally been recognized in the United States.

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