Ethnic Variations in Duodenal Villous Atrophy Consistent With Celiac Disease in the United States

Abstract

Background & Aims Celiac disease is a common disorder with a worldwide distribution, though the prevalence among different ethnicities varies. We aimed to measure the prevalence of duodenal villous atrophy among patients of different ethnicities throughout the United States (US). Methods We performed a cross-sectional study of all patients who had duodenal biopsies submitted to a national pathology laboratory between January 2, 2008 and April 30, 2015. The prevalence of villous atrophy was calculated for the following ethnicities, using a previously published algorithm based on patient names: North Indian, South Indian, East Asian, Hispanic, Middle Eastern, Jewish, and other Americans. Results Among all patients (n=454,885), the median age was 53 years and 66% were female. The overall prevalence of celiac disease was 1.74%. Compared to other Americans (n=380,163; celiac disease prevalence 1.83%), celiac disease prevalence was lower in patients of South Indian (n=177, 0%; P=.08), East Asian (n=4700, 0.15%; P=<.0001), and Hispanic (n=31,491, 1.06%; P=<.0001) ethnicities. Celiac disease was more common in patients from the Punjab region (n=617, 3.08%) than in others from North India (n=1195, 1.51%; P=.02). The prevalence of celiac disease among patients of Jewish (n=17,806, 1.80%; P=.78) and Middle Eastern (n=1903, 1.52%; P=.33) ethnicities was similar to that of other Americans. Among Jewish individuals (n=17,806), the prevalence of celiac disease was 1.83% in Ashkenazi persons (n=16,440) and 1.39% in Sephardic persons (n=1366; P=.24). Conclusions Among patients undergoing duodenal biopsy, individuals from the Punjab region of India constitute the ethnic group in the US with the highest prevalence of villous atrophy consistent with celiac disease. Compared to other Americans, villous atrophy prevalence on duodenal biopsy is significantly lower among US residents of South Indian, East Asian, and Hispanic ancestry.

The clinical and phenotypical assessment of seronegative villous atrophy; a prospective UK centre experience evaluating 200 adult cases over a 15-year period (2000–2015)

“…These findings are the first to be reported outside of the tropics and in a Western society 25. The clinical relevance of this also expands to the USA where results from a national pathology database have identified that among patients undergoing duodenal biopsies it is those from the Punjab region of India that constitute the ethnic group with the highest prevalence of villous atrophy 52. It remains to be determined whether such patients had SNVA given that the US National Health and Nutrition Examination survey has found positive coeliac serology to be rare among non-whites 1…”

Screening for Celiac Disease in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis

“…The prevalence of both IBS and CD vary, depending on ethnicity and geographical location (7,(70)(71)(72), likely reflecting differences in diet, genetics, and culture. This metaanalysis included studies from multiple countries, recruiting patients of different ethnic origins.…”

Celiac disease and Helicobacter pylori infection in children: Is there any Association?

“…Although our knowledge of CD is rapidly increasing, the possible role of Helicobacter pylori (HP) infection in CD, needs further evaluation. HP infection could influence the inflammatory and immune responses in small intestine and may therefore lead to the development of gluten‐related enteropathy in genetically predisposed individuals . In epidemiological and histomorphological studies, HP is shown as major etiological factor in patients with peptic ulcer disease, primary gastric mucosa associated lymphoid tissue lymphoma and gastric cancer …”

“…HP infection could influence the inflammatory and immune responses in small intestine and may therefore lead to the development of gluten-related enteropathy in genetically predisposed individuals. [4][5][6] In epidemiological and histomorphological studies, HP is shown as major etiological factor in patients with peptic ulcer disease, primary gastric mucosa associated lymphoid tissue lymphoma and gastric cancer. 7,8 Epidemiological studies have not proved an association between severe gastritis and CD.…”