Systematic Review: Worldwide Variation in the Frequency of Coeliac Disease and Changes Over Time

J. Y. Kang; A. H. Y. Kang; A. Green; K. A. Gwee; K.Y. Ho


Aliment Pharmacol Ther. 2013;38(3):226-245. 

In This Article

Abstract and Introduction


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.


Coeliac disease (CD) occurs when ingestion of gluten by genetically susceptible persons leads to immunologically induced small intestinal mucosal damage. Until the 1990s, CD was thought to occur mainly among White Europeans[1] and deemed uncommon in the Middle East, North Africa and even North America, whose White population is of European origin.[2] CD has since been shown to be as common in these latter countries as in Western Europe, low levels of clinical suspicion and availability of healthcare resources accounting for the previous underdiagnosis. In the Far East and sub-Saharan Africa, CD is still rarely diagnosed. This was thought to be due to a low prevalence of the HLA antigens DQ2 in these populations.[3]

Racial and geographical differences in disease frequency highlight the interplay between genetic and environmental factors. We hypothesise that there are indeed significant geographical differences in the frequency of CD and that the incidence and prevalence of CD is increasing. We carried out a systematic review on CD frequency in different populations and at different times to test our hypotheses and to examine possible reasons for any difference found.