Celiac disease in the Mediterranean area

BMC Gastroenterol. 2014 Feb 11;14:24. doi: 10.1186/1471-230X-14-24.


Background: The World Gastroenterology Organization recommends developing national guidelines for the diagnosis of Celiac Disease (CD): hence a profile of the diagnosis of CD in each country is required. We aim to describe a cross-sectional picture of the clinical features and diagnostic facilities in 16 countries of the Mediterranean basin. Since a new ESPGHAN diagnostic protocol was recently published, our secondary aim is to estimate how many cases in the same area could be identified without a small intestinal biopsy.

Methods: By a stratified cross-sectional retrospective study design, we examined clinical, histological and laboratory data from 749 consecutive unselected CD children diagnosed by national referral centers.

Results: The vast majority of cases were diagnosed before the age of 10 (median: 5 years), affected by diarrhea, weight loss and food refusal, as expected. Only 59 cases (7.8%) did not suffer of major complaints. Tissue transglutaminase (tTG) assay was available, but one-third of centers reported financial constraints in the regular purchase of the assay kits. 252 cases (33.6%) showed tTG values over 10 times the local normal limit. Endomysial antibodies and HLA typing were routinely available in only half of the centers. CD was mainly diagnosed from small intestinal biopsy, available in all centers. Based on these data, only 154/749 cases (20.5%) would have qualified for a diagnosis of CD without a small intestinal biopsy, according to the new ESPGHAN protocol.

Conclusions: This cross-sectional study of CD in the Mediterranean referral centers offers a puzzling picture of the capacities to deal with the emerging epidemic of CD in the area, giving a substantive support to the World Gastroenterology Organization guidelines.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Africa, Northern
  • Anorexia / etiology
  • Antibodies / blood
  • Biopsy / statistics & numerical data*
  • Celiac Disease / diagnosis*
  • Celiac Disease / genetics
  • Celiac Disease / pathology
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Diarrhea / etiology
  • Europe, Eastern
  • Female
  • GTP-Binding Proteins
  • Genotyping Techniques / statistics & numerical data*
  • HLA Antigens / genetics
  • Haplotypes
  • Humans
  • Infant
  • Intestine, Small / pathology*
  • Male
  • Mediterranean Region
  • Practice Guidelines as Topic
  • Protein Glutamine gamma Glutamyltransferase 2
  • Retrospective Studies
  • Serologic Tests / statistics & numerical data*
  • Transglutaminases / blood
  • Vomiting / etiology
  • Weight Loss


  • Antibodies
  • HLA Antigens
  • Protein Glutamine gamma Glutamyltransferase 2
  • Transglutaminases
  • GTP-Binding Proteins