The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school-age subjects

Acta Paediatr Suppl. 1996 May;412:29-35. doi: 10.1111/j.1651-2227.1996.tb14244.x.

Abstract

Background: Recent studies suggest that coeliac disease (CD) is one of the commonest, life-long disorders in Italy. The aims of this multicentre work were: (a) to establish the prevalence of CD on a nationwide basis; and (b) to characterize the CD clinical spectrum in Italy.

Patients and methods: Fifteen centres screened 17,201 students aged 6-15 years (68.6% of the eligible population) by the combined determination of serum IgG- and IgA-antigliadin antibody (AGA) test; 1289 (7.5%) were IgG and/or IgA-AGA positive and were recalled for the second-level investigation; 111 of them met the criteria for the intestinal biopsy: IgA-AGA positivity and/or AEA positivity or IgG-AGA positivity plus serum IgA deficiency.

Results: Intestinal biopsy was performed on 98 of the 111 subjects. CD was diagnosed in 82 subjects (75 biopsy proven, 7 not biopsied but with associated AGA and AEA positivity). Most of the screening-detected coeliac patients showed low-grade intensity illness often associated with decreased psychophysical well-being. There were two AEA negative cases with associated CD and IgA deficiency. The prevalence of undiagnosed CD was 4.77 x 1000 (95% CI 3.79-5.91), 1 in 210 subjects. The overall prevalence of CD, including known CD cases, was 5.44 x 1000 (95% CI 4.57-6.44), 1 in 184 subjects. The ratio of known to undiagnosed CD cases was 1 in 7.

Conclusions: These findings confirm that, in Italy, CD is one of the most common chronic disorders showing a wide and heterogeneous clinical spectrum. Most CD cases remain undiagnosed unless actively searched.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Adolescent
  • Antibodies / blood
  • Antibodies / immunology
  • Autoimmunity
  • Biomarkers / blood
  • Celiac Disease / complications
  • Celiac Disease / diagnosis*
  • Celiac Disease / epidemiology
  • Celiac Disease / immunology
  • Child
  • Female
  • Follow-Up Studies
  • Gliadin / immunology
  • HLA-D Antigens / genetics
  • Humans
  • Immunoglobulin A / blood
  • Immunoglobulin A / immunology
  • Immunoglobulin G / blood
  • Immunoglobulin G / immunology
  • Italy
  • Male
  • Mass Screening / methods*
  • Prevalence
  • Sensitivity and Specificity
  • Serologic Tests / methods

Substances

  • Antibodies
  • Biomarkers
  • HLA-D Antigens
  • Immunoglobulin A
  • Immunoglobulin G
  • Gliadin