Diagnostic Dilemmas in Celiac Disease

Michael X Ma; Mina John; Geoffrey M Forbes


Expert Rev Gastroenterol Hepatol. 2013;7(7):643-655. 

In This Article

Tip of the Iceberg

CD has traditionally been considered a disease affecting Caucasians of northern European descent with prevalence of about 1% in these populations.[1] However, epidemiologic studies increasingly demonstrate CD as a global disease with a heterogeneous prevalence.[2–6] For example, a European prevalence screening study based upon serology revealed that the prevalence of CD is relatively high in Finland (2.4%), and low in Germany (0.3%) and Italy (0.7%).[7]

Serologic screening studies have reported an increasing incidence of CD to the magnitude of two- to fivefold over the past 50 years.[8,9] This increase is multifactorial: a true rise in disease incidence over time, increasing awareness of CD among clinicians and the general population, and greater utilization of serological tests identifying patients with either atypical presentations or who are asymptomatic. Yet, population studies suggest that the majority of patients with CD remain undiagnosed. For example, although 70% of individuals with CD were diagnosed in a Finnish study,[10] only 5% were diagnosed in a community-based study from the USA.[11] Although CD prevalence is relatively high in Finland, implementation of education programs encouraging primary care medical staff to identify at-risk groups and subtle disease manifestations also aided greater CD detection in the former study.[10] Given, CD is a treatable condition, improved disease detection will have significant public health benefits but still remains a major challenge.