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  • Jefferson Adams
    Jefferson Adams

    Celiac Disease in Northern India More Common Than Previously Believed

    Reviewed and edited by a celiac disease expert.

    Celiac.com 03/23/2011 - A group of researchers in India recently conducted a community-based study on the prevalence of celiac disease in the northern part of India.

    The research group included Govind K Makharia, Anil K Verma, Ritvik Amarchand, Shinjini Bhatnagar, Prasenjit Das, Anil Goswami, Vidyut Bhatia, Vineet Ahuja, Siddhartha Datta Gupta and Krishnan Anand.

    They are affiliated with the Departments of Gastroenterology and Human Nutrition, and Pediatrics and Pathology at the Centre for Community Medicine of the All India Institute of Medical Sciences in New Delhi.

    Worldwide celiac disease rates are estimated at about 1%, but the disease is thought to be uncommon in both India and Asia. However, there has generally been a lack of study data on the actual prevalence of celiac disease in Asian nations.

    The research team set out to accurately estimate the prevalence of celiac disease in a specific Indian community. The team crafted a cross sectional study to estimate rates of celiac disease in urban and rural populations in the National Capital Region, Delhi, India.

    The team gathered data using a structured questionnaire administered via door-to-door visits. The questionnaire provided socio-demographic data and basic screening for features of celiac disease, such as chronic or recurrent diarrhea, and anemia.

    For children, the questionnaire included additional factors, namely short stature (linear height below 5th percentile for age) and failure to thrive/gain weight.

    All test subjects with positive screens and 10% of negative screen individuals were called for anti-tissue transglutaminase antibody blood test.

    All those with positive blood tests were invited to undergo endoscopic biopsy. The team diagnosed celiac disease on the basis of a positive blood screens, the presence of villous atrophy and/or response to gluten free diet.

    The team contacted 12,573 people in all. A total of 10,488 (83.4%) (50.6% male) agreed to participate. Screening showed 5,622 (53.6%) positive results. Of those who screened positive, 2167 (38.5%) submitted to anti-tissue transglutaminase antibody blood tests. The team also tested 712 (14%) subjects who had tested negative.

    The data showed an overall sero-prevalence of celiac disease was 1.44% (95% conï¬dence interval [CI] 1.22 1.69) and the overall prevalence of celiac disease was 1.04% (95% CI 0.85 1.25).

    Celiac disease in this north Indian community is 1 in 96, or about 1%. That means that celiac disease is more common than is recognized in India, and that rates are about the same as in other parts of the world, not lower, as conventional wisdom has held.

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    There is an error in this article: "All test subjects with positive blood screens and 10% of screen negative individuals were called for anti-tissue transglutaminase antibody blood tests."

     

    The word "blood" is in error. All test subjects who reported chronic or recurrent diarrhea and/or anemia, as well as children with short stature and/or failure to thrive or gain weight were THEN called back for the blood test, which was for the anti-tissue transglutaminase antibody.

     

    Perhaps the most important conclusion of the study was left out of this article as well:

     

    "The diagnostic criteria for celiac disease requires small-intestinal mucosal villous atrophy with crypt hyperplasia (Marsh III). However, mucosal damage develops gradually and patients may develop clinical symptoms even before classical histological changes have appeared. Two recent studies by Kurppa et al., all have elegantly demonstrated that even those with a positive serology and no villous atrophy do respond to a gluten free diet. In a subset of patients having Marsh I–II histology and positive serology, Kurppa et al. in a randomized controlled trial demonstrated alleviation of symptoms, decrease in antibody titers and improvement in histology in those who were randomized to receive gluten-free diet while there was deterioration in the small intestinal lesions in those who were continued on a gluten diet. In another study, the same author showed similar observations in anti- endomysial antibody positive children with either completely normal histology (Marsh 0) or at most Marsh I lesions. These two studies are quite intriguing and may lead to a change in the diagnostic criteria of celiac disease."

     

    The paper, "Prevalence of Celiac Disease in the Northern Part of India: A Community-Based Study," was presented in the Asia Pacific Digestive Week 2010 in Kuala Lumpur, Malasia. The abstract was published in the Journal of Gastroenterology and Hepatology (J Gastroenterol Hepatol 2010; 25 (Suppl 2): A12).

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    Guest Prof. V.K.Bharadwaj

    Posted

    At least in cases serologically positive but histologically negative for celiac disease; in these cases, stool test for fat could have been done.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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