Celiac disease in the Mediterranean area

Abstract

BackgroundThe World Gastroenterology Organization recommends developing national guidelines for the diagnosis of Celiac Disease (CD): hence a profile of the diagnosis of CD in each country is required. We aim to describe a cross-sectional picture of the clinical features and diagnostic facilities in 16 countries of the Mediterranean basin. Since a new ESPGHAN diagnostic protocol was recently published, our secondary aim is to estimate how many cases in the same area could be identified without a small intestinal biopsy.MethodsBy a stratified cross-sectional retrospective study design, we examined clinical, histological and laboratory data from 749 consecutive unselected CD children diagnosed by national referral centers.ResultsThe vast majority of cases were diagnosed before the age of 10 (median: 5 years), affected by diarrhea, weight loss and food refusal, as expected. Only 59 cases (7.8%) did not suffer of major complaints. Tissue transglutaminase (tTG) assay was available, but one-third of centers reported financial constraints in the regular purchase of the assay kits. 252 cases (33.6%) showed tTG values over 10 times the local normal limit. Endomysial antibodies and HLA typing were routinely available in only half of the centers. CD was mainly diagnosed from small intestinal biopsy, available in all centers. Based on these data, only 154/749 cases (20.5%) would have qualified for a diagnosis of CD without a small intestinal biopsy, according to the new ESPGHAN protocol.ConclusionsThis cross-sectional study of CD in the Mediterranean referral centers offers a puzzling picture of the capacities to deal with the emerging epidemic of CD in the area, giving a substantive support to the World Gastroenterology Organization guidelines.

Variability of anti-human transglutaminase testing in celiac disease across Mediterranean countries

“…In the next 10 years, at least 5 million individuals in Mediterranean countries[1,2] might benefit from the accuracy of TGA estimation, especially in light of the direct correlation between TGA titre and villous atrophy[7]. …”

HLA Typing and Histopathologic Features of Patients with Celiac Disease-A Retrospective Study

“…Lately, European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) published some new diagnostic criteria; anti-tTG levels 10-fold high the upper limit of normal, positive EMA antibodies and specific HLA haplotype. These criteria simplify the diagnosis of CD [4]. In some selected patients with symptomes of CD, small bowel biopsy can be avoided by these criteria [4,22,23].…”

“…These criteria simplify the diagnosis of CD [4]. In some selected patients with symptomes of CD, small bowel biopsy can be avoided by these criteria [4,22,23]. The quality of serological tests and the rare usage of HLA testing are the limitations at the diagnosis of CD without a small bowel biopsy.…”

“…The quality of serological tests and the rare usage of HLA testing are the limitations at the diagnosis of CD without a small bowel biopsy. So, both of these tests are important tools in the diagnosis if they are performed at qualified laboratories [4]. Polimerase Chain Reaction-Sequence Specific Primer (PCR-SSP) is an accurate HLA typing technique with high sensitivity, specificity and reproducibility.…”

“…The disease is common in Europe, particularly in Finland, Italy, Ireland and Sweden where the reported prevalence is as high as 0.3-1% [3]. CD is more common in females according to males [4]. The main problem in celiac disease (CD) is the increased sensibility to a protein, called gluten.…”