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Celiac on the Rise in Middle Eastern and North African Countries


Celiac in Africa and Middle East (photo: CC/srbyus)

Celiac.com 07/01/2010 - Celiac disease is a genetic auto-immune disease which, until now,  has primarily been considered a Western epidemic. However, we are seeing a rise of celiac disease  in  Middle Eastern and North African countries.

Celiac disease prevalence is grossly underestimated by the medical profession and as such, there is very little data available regarding malignant complications resulting from undiagnosed celiac.

Once considered a Western epidemic, celiac is now acknowledged as a common disease among North African and Middle Eastern populations. A research team at the Division of Gastroenterology, department of Internal Medicine, American University of Beirut Medical Center, formally assess why celiac disease is rising in North Africa and the Middle East. The researchers use the electronic databases pubMed and Medline from 1950 through 2008 for the search engine, and “celiac disease” was used for a Mesh term. For this study, the perimeters of the search for celiac prevalence was limited to the Middle East and North African countries only.

Celiac disease is demonstrated to be prevalent in first and second degree relatives of patients with celiac. In the US the prevalence is shown to be between 4% and 12% as assessed by biopsy. Studies in Algeria and Turkey showed a prevalence of 1.7% respectively among first degree relatives. Of the 381 first degree relatives that  were tested, 26 had positive serology,  and villous atrophy was found in 13 of the 16 patients that had biopsy's performed.  Celiac disease clusters among families were also present in Jordan and Algeria. It is noted that the high rate of consanguinity in Middle Eastern and North African countries may be responsible for generating a greater prevalence of celiac. However, further studies on this subject are needed .

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Clinical variations in presentation of celiac disease were also studied by the researchers. There are many variations when it comes to the results for clinical variations. It is suggested that the reason for the variations may be due to  the small number of patients studied, or delay in their presentation of symptoms.  Gastrointestinal discomfort is the  most common symptom of celiac disease, including diarrhea, constipation, bloating, flatulence, nausea and vomiting. Studies performed in Middle Eastern and North African countries had a celiac prevalence of 6.5%-21%. Patients with celiac disease in Iran, Lebanon, Iraq, Saudi Arabia and Kuwait had diarrhea as the most common symptom of celiac. 4.7% of Egyptian children exhibiting  diarrhea and failure to thrive, had celiac disease.

Approximately one third of children with celiac in Western countries exhibit short stature. The highest prevalence of short stature is found in Jordan, where 26% of children with celiac disease also had rickets. In Turkey, 51% of patients with celiac had a height well below the standard mean. In the United States, 36% of Americans with celiac were previously diagnosed with irritable bowl syndrome (IBS) and in Iran 12% of those labeled with IBS were later diagnosed with celiac disease.

Iron deficiency anemia (IDA) is the most common form of anemia, and is often sited as the only way to diagnose sub-clinical celiac disease in patients.  Worldwide, the prevalence of celiac among patients with IDA is 2.8% to 8.7%,  and possibly as high as 15%. In North Africa and the Middle East, anemia is found in 20%-80% of celiac patients. In Egypt, 4% of insulin dependent diabetes mellitus (IDDM) patients with anemia had celiac disease. In Saudi Arabia, the osteomalacia and IDA account for 43.5%  of celiac patients. The high prevalence of osteoporosis may be attributed to delays in celiac diagnosis.

Approximately 30% of celiac patients have other autoimmune diseases like IDDM and autoimmune thyroiditis. IDDM has very high rates among those with celiac disease with rates from 6.7% to 18.5%.  The rates for autoimmune diseases are are a low 1.9% in Turkey, and a high 33% in Iran. Many of those patients were discovered to also have celiac disease after long delays.

Whether or not prevalence of celiac is rising in Middle Eastern and North African countries is not clear, and more studies are required. More studies are also needed to determine the connections between celiac and other diseases. Reason's sited for the lack of data regarding celiac in Middle Eastern and North African countries,  are the inconsistencies with screening methods from different populations and socioeconomic back grounds,  the efficacy of treatment modalities employed, patient compliance, disease complications and response to treatments.

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REALLY odd call out here, I am attending a anime convention called A-Fest in Dallas come August, I need someone to split the room with it who is gluten-free. I take extra precautions, I COOK all the food, bring only CERTIFIED foods into the room, The room will be Gluten Free, Corn Free, Dairy Free, Peanut Free. I am trying to find someone to split the room cost with, that would be safe to be around I CAN NOT AFFORD to get sick at one of these things, it is one of my few joys left in life and get very paranoid around them. So I need someone who is also gluten-free to make sure the room stays safe (YES I have done with with a non celiac with the rules down and well stuff happens so not chancing it). Room split is food coverage comes to $400 if it is just two people. 4 day convention, I will arrange a meal plan around your diet as long as it is free of my allergens. I will also provide various snacks, baked goods, and even stuff to take home with you. https://animefest.org/ ^Convention info.

Hi Jennifer, This thread might have some information that would help you. Your doctors are pretty lame IMHO. Perhaps you can find a celiac group in your area that has local meetings for support. They might also suggest a different doctor who knows how to treat celiac patients.

All the above posts are full of good advice. What I'd like to add is, if you have coeliac disease and continue to eat gluten, you run the risk of other autoimmune diseases in the future as well as osteoporosis, malnutrition and even cancer, so even if you had no symptoms at the beginning, and may also not have any symptoms if you eat gluten (not all coeliacs do), the damage is still being done to your gut and the rest of your body, so please be aware of this.

You could possibly try calling the places in Texas and Chicago to see if they can refer you somewhere that does accept your insurance. Oh good luck to you!

Hi Jennifer and welcome CyclingLady has given you some good advice above. You want certainty and that's entirely understandable. Go back to your doctors and explain that you need to know a little more and hopefully they will engage positively with you. If they don't, then do pursue a second opinion. I just wanted to address your last paragraph quoted above. The problem with celiac, or in my case non celiac gluten sensitivity, is that it presents or doesn't present in so many different ways. It can do hidden damage which may take many years to become apparent. It can impact in ways which are incredibly difficult to recognise or isolate. I am 'lucky' in that the way that gluten impacts on me is far worse than any mental or social isolation brought upon by the diet, so motivation is easy for me, even without the certainty of a celiac diagnosis, there really is no alternative, I don't think I'd last long on a gluten diet now. But I can well understand how difficult it may be to stay honest on the diet if you don't have any symptoms to deal with. The diet can be isolating, there does become a distance between you and 'normal' people. Who would want to deal with all that if they didn't have to? If you aren't satisfied with your doctors responses and choose to go back onto gluten I suggest you find another doctor and go back into the diagnostic process and properly exclude celiac, including a scope. Otherwise you could be taking a big risk with yr long term health. You may find that this process supplies you with an answer as if your diagnosis was correct your response to the reintroduction of gluten may surprise you, or not of course! best of luck!