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World J Gastroenterol. Apr 21, 2007; 13(15): 2153-2159
Published online Apr 21, 2007. doi: 10.3748/wjg.v13.i15.2153
Celiac disease in the developing countries: A new and challenging public health problem
Francesco Cataldo, Giuseppe Montalto
Francesco Cataldo, Department of Paediatrics, University of Palermo, Palermo, Italy
Giuseppe Montalto, Department of Clinical Medicine, University of Palermo, Palermo, Italy
Author contributions: All authors contributed equally to the work.
Correspondence to: Professor Francesco Cataldo, Pediatric Clinic-Aiuto Materno Hospital, Via Lancia di Brolo 10/B, 90135 Palermo, Italy. cescocat@freemail.it
Telephone: +39-91-6834121 Fax: +39-91-6834121
Received: July 1, 2006
Revised: December 1, 2006
Accepted: January 4, 2007
Published online: April 21, 2007
Abstract

In the past, celiac disease was believed to be a chronic enteropathy, almost exclusively affecting people of European origin. The availability of new, simple, very sensitive and specific serological tests (anti-gliadin, anti-endomysium and anti-transglutaminase antibody assays) have shown that celiac disease is common not only in Europe and in people of European ancestry but also in the developing countries where the major staple diet is wheat (Southern Asia, the Middle East, North West and East Africa, South America), both in the general population and in the groups at risk. Gluten intolerance thus appears to be a widespread public health problem and an increased level of awareness and clinical suspicion are needed in the New World where physicians must learn to recognize the variable clinical presentations (classical, atypical and silent forms) of celiac disease. In the developing countries, both serological screening in the general population and serological testing in groups at risk are necessary for an early identification of celiac patients. The gluten-free diet poses a challenging public health problem in the developing countries, especially since commercial gluten-free products are not available.

Keywords: Celiac disease; Developing countries