Systematic review: worldwide variation in the frequency of coeliac disease and changes over time

Abstract

Summary Background Coeliac disease (CD), originally thought to be largely confined to Northern Europe and Australasia and uncommon in North America and the Middle East, is now recognised to be equally common in all these countries. It is still thought to be rare in the Orient and Sub‐Saharan Africa. Aim To assess geographical differences and time trends in the frequency of CD. Methods Medline and Embase searches were conducted on 10 November 2012, from 1946 and 1980 respectively, using the key words: coeliac disease or celiac disease + prevalence or incidence or frequency. Results There were significant intra‐ and inter‐country differences in the prevalence and incidence of CD. Only 24 ethnic Chinese and Japanese patients have been reported in the English literature. Of CD‐associated HLA DQ antigens, DQ2 occurs in 5–10% of Chinese and sub‐Saharan Africans, compared to 5–20% in Western Europe. DQ8 occurs in 5–10% of English, Tunisians and Iranians, but in <5% of Eastern Europeans, Americans and Asians. The prevalence and incidence of both clinically and serologically diagnosed CD increased in recent years. These geographical and temporal differences seem genuine, although variable indices of suspicion and availability of diagnostic facilities are confounding factors. Conclusions Coeliac disease is increasing in frequency, with significant geographical differences. Although few cases have been described to date in the Orient and Sub‐Saharan Africa, there is a significant prevalence of HLA DQ2 and wheat consumption is of the same order as that in Western Europe. CD may therefore become more common in the future in these countries.

Prevalence of Genetic Susceptibility for Celiac Disease in Blood Donors in São Paulo, Brazil

“…HLA-DQ8, which is present in less than 5% of West Europeans, Americans and Asians, was found in 5%-10% of English, Tunisians and Iranians (14) .…”

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.…”

Age-related differences in celiac disease: Specific characteristics of adult presentation

“…The current prevalence of CD ranges between 1/100-1/500 subjects depending to the different populations surveyed and the method employed, with a higher positive diagnosis in females [2] . The accuracy of CD prevalence has been substantially improved by the high sensitivity and specificity of serological tests detecting anti-endomysial, anti-tissue transglutaminase or antideamidated gliadin antibodies.…”

“…The pediatric population was not analyzed in these studies, but prevalence of over 1%, even in older populations, is similar to that observed in pediatric studies. A recent systematic review on world CD frequency in recent years, mainly based on European studies, found variable ratios of prevalence and incidence, which was similar, in many cases, between children and adults [2] . Although a hypothesis based on the evolution of pediatric CD towards latency would explain a lower frequency in adults; more studies on the natural evolution of this disease are needed in order to confirm it.…”

“…Although the long standing assumption is that CD develops in childhood, the disease can occur at any age. The epidemiology and symptomatology of CD have both considerably changed in recent years, with a significant increase in adult prevalence that was not previously suspected [2] . The clinical presentation of CD has also changed, from typical malnutrition to oligosymptomatic cases such as anemia, osteoporosis and even asymptomatic cases diagnosed by screening high-risk groups [3,4] .…”