Carlo Catassi; Alessio Fasano


Curr Opin Gastroenterol. 2008;24(6):687-691. 

In This Article

Globalization of Celiac Disease

Until recently the geographical distribution of celiac disease was mostly restricted to Europe and other developed countries, such as the USA, Canada, and Australia. New epidemiological studies have provided evidence that this disorder is also common in other parts of the world including the Asian continent.

The major celiac disease predisposing genotypes (HLA-DQ2 and HLA-DQ8) are common throughout the Indian continent. In northern India, the prevalence of HLA-DQ2 and HLA-DQ8 in the general population has been estimated as being 9.9 and 15.6%, respectively, whereas in southern, Dravidian-speaking populations, the prevalence of cis DQ2 and DQ8 is 4.4-7.3 and 4.7-5.1%, respectively. Wheat consumption is higher in the so-called 'celiac belt', that is the northwestern group of states where this cereal is the staple diet. This finding explains why celiac disease has mostly been described in northern India.[3] Celiac disease cases reported from India were 130 between the years 1966 and 2000 versus 517 between the years 2001 and 2005. The major factor that resulted in increased reports of celiac disease from India was use of serologic testing, for example EMA and antitTG testing, to overcome diagnostic overlap with tropical sprue, tuberculosis, and small bowel bacterial overgrowth. By using a case-finding approach (antitTG serological testing on symptomatic individuals), Sood et al.[4] reported a prevalence of newly diagnosed celiac disease of one in 310 children on a sample of 4347 school-age children from Punjab, India. Clinical series from India usually described typical or 'hypertypical' cases, being chronic diarrhea, anemia, and stunting the commonest symptoms in children. However, more recently, atypical celiac disease cases presenting with short stature, anemia, abdominal distention, rickets, constipation, diabetes mellitus, and delayed puberty have been reported.[5] Children with atypical celiac disease are significantly older than classical cases.[5]

In China and other Asian countries, the epidemiology of celiac disease is currently unknown. This region, however, shows a clear slowing of per capita consumption of rice and a parallel increased consumption of wheat-based products. Rising income and urbanization are driving forces in the increase in wheat consumption. Whereas wheat is considered an inferior food in Western societies, in the traditional rice-eating Asian countries, wheat is becoming a preferred staple. Because of these alimentary trends, an increasing incidence of celiac disease in Eastern countries can be expected in the near future.


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