World J Gastroenterol. 2010 March 28; 16(12): 1449-1457.
Published online 2010 March 28. doi: 10.3748/wjg.v16.i12.1449.
Celiac disease in Middle Eastern and North African countries: A new burden?
Kassem Barada, Abbas Bitar, Mohamad Abdul-Razak Mokadem, Jana Ghazi Hashash and Peter Green.
Kassem Barada, Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 110 72020, Lebanon
Abbas Bitar, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 110 72020, Lebanon
Mohamad Abdul-Razak Mokadem, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Jana Ghazi Hashash, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Peter Green, Division of Gastroenterology, Department of Internal Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, United States
Author contributions: All authors contributed equally to the manuscript.
Correspondence to: Kassem Barada, MD, Professor, Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Beirut 110 72020, Lebanon. kb02@aub.edu.lb
Telephone: +961-3-780909 Fax: +961-1-370814
Received September 4, 2009; Revised November 16, 2009; Accepted November 23, 2009;
Abstract
Celiac disease (CD) is now recognized as a common disorder among Middle Eastern (ME) and North African (NA) populations. The aim of this review is to assess the available data regarding CD in the ME and NA and to compare this information with that of Western countries. A literature review was performed using the electronic databases PubMed and Medline (1950-2008) as search engines, and “celiac disease” was used as a Mesh term. The search was limited to ME and NA countries. The prevalence of CD in ME and NA countries among low risk populations is similar to that of Western countries, but is higher in high risk populations such as those with type 1 diabetes. It is underestimated because of lack of clinical suspicion and lack of patient awareness. Clinical presentations in term of gastrointestinal, hematologic, skeletal, and liver manifestations are similar between both populations except for a high prevalence of short stature in some ME and NA countries. Few studies have addressed atypical or silent CD. As in the West, diagnosis is initially made by serological tests and is confirmed by small intestinal biopsies. Gluten-free diet is the main mode of treatment with a higher apparent adherence rate than in the West. Most disease complications result from malabsorption. The disease is strongly associated with HLA DQ2 and to a lesser extent with HLA DQ8 alleles. In conclusion, CD prevalence is underestimated, with little data available about its malignant complications. Disease parameters in the ME and NA are otherwise similar to those in Western countries.
Keywords: Celiac disease, Gluten-free diet, Insulin dependent diabetes mellitus, Iron deficiency anemia, Middle East