A 10-year serological follow-up of celiac disease in an Estonian population

Lillemäe, Kadri; Ress, Krista; Harro, Jaanus; Merenäkk, Liis; Maaroos, Heidi‐Ingrid; Uibo, Raivo; Uibo, Oivi

doi:10.1097/meg.0b013e32834d09b9

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…The present study is the first on celiac disease epidemiology in Latvia, one of the three Baltic countries in Northeastern Europe where considerable political and socioeconomic changes have taken place over the last century. A previous study conducted in schoolchildren from Estonia, another Baltic country, revealed a 0.34% prevalence of celiac disease 33, 34 . In Polish children the prevalence of confirmed celiac disease is 0.25%, but the prevalence of positive serology is 0.8% 35…”

Section: Discussionmentioning

confidence: 92%

“…A previous study conducted in schoolchildren from Estonia, another Baltic country, revealed a 0.34% prevalence of celiac disease. 33,34 In Polish children the prevalence of confirmed celiac disease is 0.25%, but the prevalence of positive serology is 0.8%. 35 Prevalence figures in epidemiological studies are substantially influenced by the criteria set for diagnosing celiac disease.…”

Section: 32mentioning

confidence: 99%

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Prevalence estimation of celiac disease in the general adult population of Latvia using serology and HLA genotyping

et al. 2015

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Background: Prevalence estimates for celiac disease (CD) depend on the method used. The role of deamidated gliadin peptide (DGP) and genetic testing in epidemiological studies and diagnostic settings of celiac disease (CD) has still to be established. Objectives: The objective of this article is to assess the prevalence of CD in Latvia by combining serological tests with DQ2.5/ DQ8 testing. Methods: A total of 1444 adults from a randomly selected cross-sectional general population sample were tested by ELISA for tTG IgA, DGP IgA and IgG antibodies (QUANTA Lite Õ , Inova Diagnostics Inc). Samples with tTG IgA !20U were tested for EMA IgA by indirect immunofluorescence assay, and all specimens with tTG IgA !15U were tested by QUANTA-Flash Õ chemiluminescent assays (CIA) (Inova Diagnostics Inc) for tTG IgA, DGP IgA and IgG. DQ2.5/8 was detected in individuals with any positive ELISA test and a subgroup of controls. Results: Forty-three individuals (2.98%; 95% CI: 2.10-3.86%) tested positive by at least one ELISA test; 41.86% of the serology-positive individuals (any test above the cutoff) were DQ positive. Six individuals (0.42%; 95% CI: 0.09-0.75%) were triple ELISA positive, and DQ2.5 or DQ8 was positive in all; 0.35% (95% CI: 0.05-0.65%) were tTG IgA and EMA positive. Two tTG IgA-negative cases were both DGP IgG and IgA positive, both being DQ positive; including them in the ''serologypositive'' group would increase the prevalence to 0.49% (95% CI: 0.13-0.85%). CIA tests revealed 2 tTG IgA-positive and EMA-negative cases with a positive genotype. DQ2.5 or DQ8 genotype was positive in 28.6% of the serology-negative population. Conclusions: Estimates of the prevalence of CD in Latvia based on the serogenetic testing approach range from 0.35% to 0.49% depending on the criteria used. There is a rationale for combining serological tests and DQ2.5/8 genotyping.

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Section: Discussionmentioning

confidence: 92%

Section: 32mentioning

confidence: 99%

Prevalence estimation of celiac disease in the general adult population of Latvia using serology and HLA genotyping

et al. 2015

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“…Second, the two groups were recruited 10 years apart, although both groups were screened using IgA‐anti‐TG2 with exactly the same method. In addition, we followed up the population studied and rescreened them with IgA‐anti‐TG2 10 years after initial recruitment without finding any new cases of CD . Therefore we consider these two groups comparable and report a four times greater risk for developing CD (odds ratio [OR] 4.18, 95% CI 1.12, 15.64) in children with AD as in the general pediatric population.…”

Section: Discussionmentioning

confidence: 99%

Celiac Disease in Children with Atopic Dermatitis

Ress

Annus

Putnik

et al. 2014

Pediatric Dermatology

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Celiac disease (CD) is an autoimmune disorder of the small intestine with highly variable clinical presentation and frequently associated with various immune-mediated diseases. Among these immune-mediated diseases, atopy has been found frequently in individuals with CD. We aimed to study the prevalence of CD in Estonian children with atopic dermatitis (AD), a common multifactorial chronic inflammatory skin disease. We recruited 351 consecutive children with active AD (mean age 5.8 yrs, 57.6% boys) at Tallinn Children's Hospital, Estonia. Sera of all patients were tested for total serum immunoglobulin (Ig) A, for IgA- and IgG-type autoantibodies to tissue transglutaminase (IgA-anti-TG2, IgG-anti-TG2) and to deamidated gliadin peptides (IgA-anti-DGP, IgG-anti-DGP). The diagnosis of CD was confirmed histologically by small intestine biopsy according to the European Society of Paediatric Gastroenterology, Hepatology and Nutrition diagnostic criteria. IgA deficiency was detected in nine patients with AD (2.6%), none of whom had IgG-anti-TG2 or IgG-anti-DGP seropositivity. IgA-anti-TG2 positivity was found in 4 (1.1%), IgG-anti-TG2 positivity in 2 (0.6%), IgA-anti-DGP positivity in 11 (3.1%), and IgG-anti-DGP in 10 (2.8%) patients. Celiac disease was confirmed in five (1.4%) patients with AD (95% confidence interval 0.46, 3.32) and all were histologically characterized as Marsh IIIa-IIIc stages and two presented with silent CD. In AD patients, CD prevalence was more than four times as high as in previously studied randomly selected schoolchildren in Estonia. Two patients with AD diagnosed with CD had no symptoms indicative of CD, in spite of extensive histologic changes in the small intestine mucosa. Therefore our study emphasizes the need for evaluating the cost-effectiveness of screening individuals with AD for CD in time to prevent long-term complications.

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“…However, population-representative screening further revealed that several countries, such as Argentina (135), Finland (113), Hungary (142, 143), Italy (121, 147–149), Spain (154), Sweden (157–160), and Turkey (163), were approaching a childhood prevalence of 1% or more. Meanwhile, countries exhibiting low CD prevalence included, among others, Estonia (138, 139), and Russia (123) (Table 4). The quite low prevalence rate observed for Denmark, even after its increase over the years (128), indicates that CD awareness is low among healthcare professionals and that serum autoantibody case-finding screening in the primary care field is not often performed.…”

Section: Incidence Rates and Prevalencementioning

confidence: 99%

Changing Pattern of Childhood Celiac Disease Epidemiology: Contributing Factors

Popp

Mäki

2019

Front. Pediatr.

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Up until the 1960s and 1970s, diarrhea, malabsorption syndrome, and failure to thrive were the presenting symptoms and signs of celiac disease (CD) in young infants; however this disease was also at the same time reported to be disappearing. Indeed, clinical childhood CD was seen to transform into a milder form, resulting in an upward shift in age at diagnosis during the 1970s (and years later for many countries). This changing pattern of CD presentation then altered the epidemiology of the disease, with major differences between and within countries observed. An awareness of the changing clinical nature of CD and use of case-finding tools to detect even clinically silent CD became an important factor in this changing epidemiology. Countries report both low and high prevalence but it seems to be on the increase resulting in a population-based level of 1–2%. This paper discusses the potential causes and environmental factors behind these observed clinical changes, identifying new clues from different studies published at the time this transformation took place. For instance, it was found that breastfeeding postponed the diagnosis of the disease but did not altogether prevent it. Moreover, gluten introduction at a young age, specifically at the mean age of 2 months, seemed to also have a clear impact in inducing malabsorption syndrome and failure to thrive in young infants in addition to other factors such as gluten intake volume and type of cereal present in the weaning food. Further, the impact of cow's milk and its high osmolarity might have played an important role; humanized milk formulas were not yet invented. Future epidemiological studies on the contributing environmental factors to the shift in CD presentation are thus recommended for countries in which these changing clinical features are still being observed.

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A 10-year serological follow-up of celiac disease in an Estonian population

Cited by 5 publications

References 27 publications

Prevalence estimation of celiac disease in the general adult population of Latvia using serology and HLA genotyping

Prevalence estimation of celiac disease in the general adult population of Latvia using serology and HLA genotyping

Celiac Disease in Children with Atopic Dermatitis

Changing Pattern of Childhood Celiac Disease Epidemiology: Contributing Factors

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