Childhood Celiac Disease May Be on the Rise

By Megan Brooks

June 09, 2021

NEW YORK (Reuters Health) - Mass screening of children suggests celiac disease is becoming more common, according to a new study from Italy.

As part of the CELI SCREEN study, researchers screened a total of 7,760 school-age children in eight different provinces throughout Italy. Their findings, presented at the 6th World Congress of Pediatric Gastroenterology, Hepatology and Nutrition, suggest that the overall prevalence of celiac disease has nearly doubled over the past 25 years from about 1.0% to 1.6%.

"In our opinion, this is a true increase, because we compared the prevalence recorded in the current study with that recorded in the 1990s by a screening study in the same type of population," Dr. Elena Lionetti of Marche Polytechnic University, in Ancona, told Reuters Health by email.

The reasons for the linear increase of celiac disease prevalence during the last decades remain unclear, she said.

"Changes of the major determinants of celiac disease, namely host genetic makeup and gluten consumption, are unlikely to explain this finding. Although increasing immigration from extra-European countries occurred during these last decades in Italy, only 10% of the study group were non-Caucasian children. Additional studies are needed to establish whether key environmental factors, such as the composition of microbiota, vaccination schedule, infections, and use of antibiotics, may have affected the tolerance-immune response equilibrium in recent decades," Dr. Lionetti said.

Children in the CELI SCREEN study were screened using a two-step process: a finger-tip blood test to determine the presence of HLA predisposing genes, followed by determination of total serum IgA and IgA anti-transglutaminase in HLA-positive children. The diagnosis of celiac disease was confirmed using the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria.

Dr. Lionetti said it's possible that the prevalence of celiac disease recorded in the past was underestimated due to the use of old serological tests (anti-gliadin antibodies).

"However, for the comparison of the prevalence in the two different periods, we used the adjusted prevalence of celiac disease that is the prevalence found in 1990 by using anti-gliadin antibodies corrected for an underestimation of about 30%. Therefore, in our opinion the prevalence of celiac disease has really doubled in the last decades (from 0.8 to 1.6%)," Dr. Lionetti told Reuters Health.

She noted that without a mass-screening strategy, 70% of celiac disease patients will remain undiagnosed due to the varied presentation of clinical signs and symptoms.

"Celiac disease is often a chameleon. A greater knowledge of the disease and of its possible clinical manifestations is strongly required in order to bring out as much as possible the iceberg of the disease currently submerged until a screening strategy for the entire population will be available," Dr. Lionetti said.

Commenting on this research in a statement, Tunde Koltai, chair of the Association of European Celiac Societies (AOECS) and patient representative of the ESPGHAN public-affairs committee, said, "This new study adds to the growing evidence base that the number of people in Europe with celiac disease is rising, yet many still remain undiagnosed."

"It is essential that we adopt an effective screening strategy for celiac disease across Europe to ensure children and the wider population are diagnosed as early as possible so that they can have the best possible quality of life," said Koltai.

The finding of increased prevalence of celiac disease in Italy mirrors what's happening in the United States. According to recent data, the incidence of celiac disease has continued to increase in the past decade in a North American population (

SOURCE: World Congress of Pediatric Gastroenterology, Hepatology and Nutrition, held June 2-5, 2021.