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The Celiac Iceberg: Characterization of the Disease in Primary Schoolchildren

Nenna, Raffaella*; Tiberti, Claudio; Petrarca, Laura*; Lucantoni, Federica*; Mennini, Maurizio*; Luparia, Rita Pia Lara*; Panimolle, Francesca*; Mastrogiorgio, Gerarda*; Pietropaoli, Nicoletta*; Magliocca, Fabio Massimo; Bonamico, Margherita*

Journal of Pediatric Gastroenterology & Nutrition: April 2013 - Volume 56 - Issue 4 - p 416–421
doi: 10.1097/MPG.0b013e31827b7f64
Original Articles: Gastroenterology

Objective: Celiac disease (CD) has a prevalence of 0.55% to 1% in Italy. Identifying CD in schoolchildren to characterize CD iceberg and evaluate the effect of diagnosis in screening-detected children.

Methods: A total of 7377 5- to 8-year-old children were invited to participate. A total of 5733 salivary samples were collected and tested for anti-transglutaminase antibodies (tTGAb), using a fluid-phase radioimmunoassay. Salivary tTGAb-positive children were analyzed for serum antibodies (anti-endomysium antibodies, radioimmunoassay, and enzyme-linked immunosorbent assay tTGAb). Positive children underwent endoscopy and then started gluten-free diet (GFD) and periodical follow-up.

Results: Forty-six subjects were found salivary tTGAb–positive and 16 border-line. Forty-five of 46 and 5 of 15 of them were also serum antibody–positive. Forty-two children showed duodenal villous atrophy and 1 had only type 1 lesions. Three children started GFD without performing endoscopy. CD prevalence (including 23 previously diagnosed children with CD) was 1.2%. Considering all 65 celiacs in our sample, a silent CD was found in 64%, typical in 28%, atypical in 7%, and potential in 1%. All patients showed strict adherence to GFD, weight and stature increase, and well-being improvement. Eighty-five percent and all but 2 screening-detected children with CD had Italian parents.

Conclusions: Our sample size, representative of primary schoolchildren of our region, demonstrated that CD prevalence is growing in Italy, with a modified clinical spectrum and iceberg deepness.

*Departments of Paediatrics

Department of Internal Medicine and Medical Specialties

Department of Experimental Medicine and Pathology, “La Sapienza” University of Rome, Rome Italy.

Address correspondence and reprint requests to Dr Raffaella Nenna, Department of Paediatrics, “La Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy (e-mail:

Received 24 July, 2012

Accepted 29 October, 2012

The study was supported financially by Comune di Roma (Assessori Lia di Rienzo and Laura Marsilio), Dr Schär and Rotaract Roma Capitolino (Francesca Cardone).

The authors report no conflicts of interest.

Copyright 2013 by ESPGHAN and NASPGHAN