High prevalence of coeliac disease in a population‐based study from Western Australia: a case for screening?

Abstract

Objectives To determine the prevalence of coeliac disease in an Australian rural community. Design Retrospective analysis of stored serum samples from 3011 random subjects from the Busselton Health Study. IgA antiendomysial antibodies (AEA) were detected by indirect immunofluorescence, and subjects testing positive were contacted and offered small‐bowel biopsy. Main outcome measures Prevalence of AEA positivity and biopsy‐proven coeliac disease in the community with reference to the proportion of symptomatic to asymptomatic patients. Results 10 of 3011 subjects were AEA positive. One subject had died, one subject could not be traced and one refused small‐bowel biopsy. All subjects with detectable AEA who consented to biopsy had pathological changes consistent with coeliac disease. The prevalence of newly diagnosed biopsy‐proven coeliac disease is 7 in 3011 (1 in 430). Two further subjects had a diagnosis of coeliac disease before this study. When all AEA‐positive patients and those previously diagnosed are included, the prevalence is 12/3011 (1 in 251). There was a significant clustering of cases in the 30–50‐years age range, with 10/12 (83%; 95% CI, 52%–98%) aged between 30 and 50 years, compared with 1092/3011 (36%; 95% CI, 35%–38%) of the total population (P<0.03). Of the eight AEA‐positive subjects who could be contacted, four had symptoms consistent with coeliac disease and four were asymptomatic. Three subjects were iron‐deficient, four subjects had first‐degree relatives with coeliac disease and one subject had type 1 diabetes mellitus. Conclusions The prevalence of coeliac disease is high in a rural Australian community. Most patients are undiagnosed, and asymptomatic.

Diagnosis and management of coeliac disease in children

“…Studies have suggested that the prevalence of CD in most countries studied is approximately 1%5 6 and about 30% of these communities carry susceptibility genes for CD HLA DQ2 (20% of Caucasians, North Africans, South and West Asians) or HLA DQ8 (10% of all Caucasians and Asians). These genes are found less commonly in some ethnic groups (pure Chinese, Japanese, Afro-Caribbean or Sub-Saharan African descent) where CD is less common 7.…”

Increasing Incidence of Celiac Disease in a North American Population

“…(6) However, real differences may also exist between regions(7) and races, as higher levels of CD have also been shown outside Europe and the US among populations of predominantly European extraction (e.g., New Zealand and Australia). (13, 14)…”

Age related clinical features of childhood Coeliac disease in Australia

“…For instance, the number of reported cases in the Netherlands increased from 0.18 per 1000 live births from 1975–1990, to 0.54 per 1000 live births 1993–1994 [1]. There is also increasing recognition that symptomatic coeliac disease may be the tip of the iceberg, with many more asymptomatic cases in the community [2-4]. …”

“…In a population based screening study from a rural community of Western Australia, 10/3001 were positive for anti-endomysial antibodies. This community was of predominantly Anglo-Celtic origin [4]. Australians come from diverse ethnic backgrounds, thus the prevalence reported in this community cannot be generalised to the Australian population.…”