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Celiac.com 10/20/2017 - Are doctors even getting close to diagnosing the actual number of cases of celiac disease? Or are they missing the vast majority? Researchers have said for some time that there are far more people with celiac disease than are being diagnosed, and that the vast majority of cases go undiagnosed. So, just how far are we from the actual number? Well, if a new study by Canadian nutrition researchers is any indication, doctors are very far from diagnosing most cases. The team studied the blood work of nearly 3,000 people, and their conclusions are stunning. They say that ninety percent of celiac cases go undiagnosed. How could this be? One reason is that even classic celiac disease symptom, such as abdominal pain, bloating, gas, diarrhea, anemia and weight loss can mimic other conditions. Less classic symptoms such as fatigue, low vitamin C, D and calcium levels can be misleading. Ahmed El-Sohemy, a professor of nutritional science at the University of Toronto, wanted to see whether celiac disease results in subpar nutrition because of poorer absorption of vitamins and minerals. But to find out, he needed Canadian data on the frequency of undiagnosed celiac disease. To that end, El-Sohemy and his colleagues checked blood samples from more than 2,800 individuals in Toronto. One group had an average age of 23, and the other 45. Among their findings is likely ~1%, with 87% of cases being undiagnosed. These findings suggest the need for better screening in high genetic risk groups. Source: BMJOPEN.com
Scott Adams posted an article in Anemia and Celiac DiseaseBr J Haematol 2000;111:898-901. Celiac.com 02/15/2001 - As reported in the December issue of the British Journal of Haematology, Dr. D. J. Unsworth of Southmead Hospital in Bristol, UK, and colleagues examined 483 blood samples that were found to be anemic (hemoglobin Results: The researchers found that by screening anemic adults for celiac disease they ended up with a detection rate of 6%, compared with 0% detection of celiac disease using EDTA blood samples from 250 non-anemic blood donors. Conclusion: Celiac disease in menstruating women is under-investigated as a potential cause of iron-deficiency anemia. Celiac disease serology is easy, cheap and reliable, and the researchers recommend that all cases of anemia with an uncertain cause, including when the only cause is though to be menstruation, be tested for celiac disease-associated autoantibodies.
BMJ 2004;328:322-323 (7 February) Celiac.com 02/18/2004 - A study conducted by researchers in the UK has found that 1% of all seven year old children in the UK have celiac disease, and most cases of celiac disease continue to remain undiagnosed. The researchers tested 5,470 "normal" children using a two stage screening that included an initial radioimmunoassay for antibodies to tissue transglutaminase (endomysial antigen), and a further testing of positive samples for IgA-EMA by indirect immunofluorescence. Children with tTG antibodies under the 97.5th percentile were defined as antibody negative. Out of those tested 54 were positive for IgA-EMA. Additionally: "IgA-EMA positive children were shorter and weighed less than those who tested negative for tTG antibody." The Researchers Comment: "At age 7, 1% of children were IgA-EMA positive and likely therefore to have sub clinical coeliac disease, though less than 0.1% were reported to be on a gluten-free diet. The prevalence of coeliac disease in these children is therefore comparable to that in UK adults. The benefit of early diagnosis of sub clinical coeliac disease remains unproven, but long term follow up of this cohort may help to resolve this. If screening is worth while, it should be started in childhood." "Since ALSPAC is an observational study based on analysis of anonymous samples, confirmatory biopsy was not possible...®eported clinical features were similar to those in adults with coeliac disease identified by screening. Gastrointestinal symptoms were not prominent, and the excess in girls mirrors that seen in affected adults. The most striking observation was that children with IgA-EMA were shorter by more than 0.76 standard deviation scores and lighter by 0.54 standard deviation scores than antibody negative children matched for date and place of birth. This equates to about 9 months growth and weight gain in an average child around this age. These features were independent of gastrointestinal symptoms and anemia and presumably unrelated to malabsorption." Conclusion: "Occult coeliac disease seems to start in childhood, even in those who are subsequently diagnosed as adults. The search for the trigger resulting in the breakdown of immune tolerance to gluten therefore needs to focus on infancy and intrauterine life."