Auteur Topic: Prevalence of celiac disease in Germany: A prospective follow-up study  (gelezen 1428 keer)


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World J Gastroenterol 2013 May 7; 19(17): 2612-2620
ISSN 1007-9327 (print) ISSN 2219-2840 (online)

Prevalence of celiac disease in Germany:
A prospective follow-up study

Wolfgang Kratzer, Monika Kibele, Atilla Akinli, Marc Porzner,
Bernhard O Boehm, Suemeyra Oeztuerk, Mark H Haenle,
Department of Internal Medicine I, University Hospital Ulm,
89081 Ulm, Germany
Wolfgang Koenig, Department of Internal Medicine II, University
Hospital Ulm, 89081 Ulm, Germany
Richard A Mason, Louis Stokes Cleveland Department of Veterans
Affairs Medical Center, Cleveland, OH 44106, United States
Ren Mao, Department of Gastroenterology, the First Affiliated
Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong
Province, China

To determine the prevalence of celiac disease in a randomly selected population sample.

A total of 2157 subjects (1036 males; 1121 females) participating in a population-based cross-sectional study
underwent laboratory testing for
tissue transglutaminase and antibodies to immunoglobulin A, endomysium and antigliadin.
In a second step, all subjects who had been examined serologically were
surveyed using a questionnaire that included questions specific to celiac disease.

Subjects with positive antibody titers and those with histories positive for celiac
disease then underwent biopsy.
At the first follow up, antibody titers were again determined in these subjects
and subjects were questioned regarding symptoms specific for celiac disease and disorders associated with celiac disease.
The second follow up consisted of a telephone interview with subjects positive for celiac disease.

Antibody tests consistent with celiac disease were reported in eight subjects, corresponding to an overall prevalence of 1:270 (8/2157).
The prevalence among women was 1:224 and 1:518 in men.
Classical symptoms were observed in 62.5% of subjects.
Atypical celiac disease was present in 25.0%, and transient celiac disease in 12.5%.
False-negative test results were returned in three subjects.

This yields a sensitivity and specificity of 62.5% and 50.0%, respectively, for
tissue transglutaminase immunoglobulin-A antibody;
of 62.5% and 71.4% respectively, for endomysium antibody;
and of 62.5% and 71.4%, respectively, for antigliadin antibody.

The prevalence rate in our collective lies within the middle tertile of comparable studies in Europe.
The use of a single antibody test for screening purposes must be called into question.

Table 1 Prevalence of celiac disease in different countries
Population-representative samples
Netherlands[5]     1:286   1440   40.6  (20-59)  46
Blood donors
Netherlands[16]   1:333   1000   NA                  NA
tTGA: Tissue transglutaminase antibody; EMA: Endomysial antibody; AGA: Antigliadin antibody; NA: Not available; -: Positive.

Figure 1 Flow of subjects across the study. tTGA: Tissue transglutaminase antibody; EMIL: Echinococcus Multilocularis and other Internal Diseases in Leutkirch;
IgA: Immunoglobulin A.

Figure 2 Subjects positive for celiac disease (based on positive antibody tests or by prior history). Total IgA: Total immunoglobulin A; tTGA IgA: Tissue transglutaminase
immunoglobulin A; AB positive: Antibody positive; AB negative: Antibody negative; n: Number of subjects; CD: Celiac disease; HLA typing: Human leukocyte
antigen typing; HLA: Human leukocyte antigen; HLA positive: Positive for Human leukocyte antigen; HLA negative: Negative for Human leukocyte antigen

Table 2 Clinical presentation in subjects with seronegative findings but with histories suggestive of celiac disease

Table 3 Change in celiac-specific antibody titers over time

Table 4 Clinical presentation, histology and human leukocyte antigen findings in subjects with celiac disease

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