Danish Study Shows Celiac Disease Highly Under-diagnosed in Adults

Celiac.com 06/24/2015 - The Danish National Patient Registry records about 50 cases of celiac disease per 100,000 persons. This is much lower than the celiac rates reported in other Nordic countries, and many doctors have suspected that the condition is being under-diagnosed.

So, how common is under-diagnosis of celiac disease? A team of researchers recently set out to answer that question by conducting a population-based study of Danish adults. The research team included A. Horwitz, T. Skaaby, L.L. Kårhus, P. Schwarz, T. Jørgensen, J.J. Rumessen, and A. Linneberg. They are affiliated with the Research Centre for Prevention and Health, The Capital Region at the University of Copenhagen in Copenhagen, Denmark.

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They screened a total of 2,297 adults aged 24-76 years living in the southwestern part of Copenhagen for celiac disease via immunoglobulin (Ig)A and IgG antibodies to transglutaminases and deamidated gliadin. They invited IgA/IgG-positive participants to a have a clinical evaluation, including biopsies, by a gastroenterologist.

Of 56 invited participants, 40 underwent a full clinical evaluation, 8 of whom were diagnosed with celiac disease. Experts considered 2 of the 16 persons who declined the clinical evaluation to be likely positive for celiac disease.

None of the above 56 participants had a known history of celiac disease or a recorded diagnosis of celiac disease in National Patient Registry.

By combining the 8 cases of biopsy-proven celiac disease, the 2 cases of probable celiac disease, and 1 registry-recorded case of celiac disease, the team calculated 11 celiac cases out of 2,297 study participants. From this number, the team estimated celiac disease rates to be 479 per 100,000 persons, for the general population (95% CI: 197-761).

This figure is 10 times higher than the registry-based prevalence of celiac disease.

Of 11 participants diagnosed with celiac disease in our screening study, 10 were unaware of the diagnosis prior to the study.

Thus, the team suggests that celiac disease is profoundly under-diagnosed in Danish adults.

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