Annual Meeting of the European Society of Pediatric Gastroenterology and Nutrition
Within the American scientific communitiy it is generally held tha CD is a rare disorder in USA, which is reflected by limited number of scientific papers published from the new continent in the past 30 years. A Med-line search revelaed that of the 6276 papers published on CD between 1966 and 1995 only 48 (0.8%) were from USA. On the contrary, using a antigliadin antibody (AGA) and antiendomysium (EmA) antibody assays, several epidemiological studies in Europe have found the prevalence of celiac disease (CD) to be about 1:300 of the population. Aim: This study was designed to determine the prevalence of positive serological tests for CD in a large group of healthy blood donors from the USA. Methods: Sera from 2000 healthy blood donors were analized for IgG and IgA AGA using an immunoenzymatic ELISA test. The upper limit for normal was 18 units for IgA and 25 units (U) for IgG. EmA was determined by indirect immunofluorescence using monkey esophagus (ME) and human umbilical cord (HUC) on slides as substrates. EmA not only was studied on AGA positive sera but on sera ≥10U for IgA and ≥15U for IgG too. The population with a mean age of 39 y. was 52.4% men and consisted of 87% Caucasian, 11.5% African-americans, 1.5% Asians. Results: 81 (4%) boold donors had elevated AGA levels. Seven of these 81 samples were positive for EmA and one sample with negative AGA values (12U for IgA, 1.8U for IgG) was EmA positive. Among the EmA+ samples, two had iron deficiency (iron <20 μg/mL, iron-bind.-capacity >700μg/mL) and one of these had low levels of folic ac. (2ng/mL) and ferritin (7ng/mL). Subjects identified as EmA positive, seven were Caucasian and one was African-american. Ema positivity (8 samples) and negativity (288 samples) was identified on both ME & HUC. Conclusions: Our results are very similar to those involving healthy blood donors from Sweden and healthy school children from Italy. Subsequent biopsies in these studies confirmed the prevalence for CD to be 3.9/1000 in Sweden and 3.8/1000 in Italy. All cases with EmA positivity had biopsy evidence of CD. Based on these findings we belive it is likely that at least 8 of blood donors screened in our study have CD. This indicates the prevalence for CD in the USA could be as high as 1:250, which is that in Europe. Our data strongly support the idea that CD is underdiagnosed in USA and should be the basis for large epidemiological studies.
Munich, June 5-8, 1996