lunes, 5 de noviembre de 2018

Coeliac Disease Epidemiology

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By Ananya Mandal, MDReviewed by April Cashin-Garbutt, MA (Cantab)

Celiac disease is an autoimmune disorder that affects the inner walls of the small intestines especially in response to presence of gluten in diet.

Prevalence in United States

On average at least 1 in 133 healthy persons in the USA suffers from gluten sensitivity and celiac disease. This means nearly 3 million Americans suffer from this disease. Despite diagnosis only around 1 in 56 persons suffer from symptoms of celiac disease.

Absence of any symptoms of the condition despite diagnosis is seen in 60% of children and 41% of adults diagnosed with celiac disease. In addition, only 35% of newly diagnosed patients present with symptoms of chronic diarrhea. This goes against the traditional belief that diarrhea must be present to diagnose celiac disease.

The average length of time it takes for a symptomatic person to be diagnosed with celiac disease in the US is four years and may take up to 10 years as well. The longer this duration the greater is the risk of the patient developing complications like osteoporosis, other autoimmune diseases and cancers.

Age at diagnosis is thus related to chances of developing autoimmune conditions:-

Diagnosed at 4 – 12 yrs of age - 16.7% chance
Diagnosed at 12 – 20 yrs of age - 27% chance
Diagnosed at over 20 yrs of age - 34% chance

The risk of getting celiac disease is higher among first degree relatives of sufferers by about 10%. First degree relatives include parents, children or siblings. The prevalence among first degree relatives is around 1 in 22 persons. The risk is also high among second degree relatives like uncles, aunts and cousins and the prevalence is 1 in 39.

Prevalence varies according to races and ethnicities. It was previously believed that only Caucasians were affected – this is not true. The estimated prevalence for African-, Hispanic- and Asian-Americans is 1 in 236.

Prevalence in the United Kingdom

In the United Kingdom prevalence of celiac disease in children by biopsy is found to be 0.5 to 1.6% and confirmed by serology to be 0.3 to 1.9%. The numbers among adults is similar with 0.07 to1.9% confirmed by biopsy and 0.2 to 2.7% confirmed by serology.

Serological tests also reveal that IgA EMA positive rates were higher in girls than in boys, odds ratio (OR) 2.12 (95% confidence interval [CI] 1.20 to 3.75).

Studies have found a prevalence of 2.8 to 17.2% with serology and 5.6 to 44.1% with biopsy among first degree relatives of sufferers of celiac disease.