Celiac disease in the Mediterranean area.
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2014-02
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Abstract
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.
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Keywords
Mediterranean area, Celiac disease, World gastroenterology organization, ESPGHAN guidelines