Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 7, 2011; 17(45): 4971-4978
Published online Dec 7, 2011. doi: 10.3748/wjg.v17.i45.4971
Burden of celiac disease in the Mediterranean area
Luigi Greco, Laura Timpone, Abdelhak Abkari, Mona Abu-Zekry, Thomas Attard, Faouzi Bouguerrà, Paskal Cullufi, Aydan Kansu, Dusanka Micetic-Turk, Zrinjka Mišak, Eleftheria Roma, Raanan Shamir, Selma Terzic
Luigi Greco, Laura Timpone, European Laboratory for Food Induced Diseases, Federico II University of Naples, 80131 Naples, Italy
Abdelhak Abkari, Hopital des Enfant Ibn Rochd de Casablanca, 20100 Casablanca, Morocco
Mona Abu-Zekry, Children’s Hospital, Gastrointestinal Unit, Cairo University, 12611 Giza, Egypt
Thomas Attard, University of Malta, Medical School, Guardamangia MSD 06, Malta
Faouzi Bouguerrà, Hopital des Enfants de Tunis, 1006 Tunis, Tunisia
Paskal Cullufi, Department of Gastroenterology and Hepatology, University Hospital Center “Mother Teresa”, nr 371 Tirana, Albania
Aydan Kansu, Department of Pediatric Gastroenterology, Ankara University, Dikimevi/Mamak, Ankara 06100, Turkey
Dusanka Micetic-Turk, University Medical Centre, Paediatric Department, Ljubljanska, 2000 Maribor, Slovenia
Zrinjka Mišak, Children’s Hospital Zagreb, 10000 Zagreb, Croatia
Eleftheria Roma, Athens University, Aghia Sophia Children’s Hospital, Goudi, 11527 Athene, Greece
Raanan Shamir, Schneider Children’s Medical Center of Israel, Tel-Aviv University, Petach-Tikva 49202, Israel
Selma Terzic, University Clinical Center Tuzla, Children's Hospital, 75000 Tuzla, Bosnia Herzegovina
Author contributions: Greco L, Timpone L, Abkari A, Abu-Zekry M, Attard T, Bouguerrà F, Cullufi P, Kansu A, Micetic-Turk D, Mišak Z, Roma E, Shamir R and Terzic S directly participated in the study, including substantial contributions to conception and design of the study and acquisition of data; Greco L, Timpone L and Shamir R analyzed the data, wrote the manuscript and provided statistical analysis of data.
Supported by European Laboratory for Food Induced Diseases, Federico II University of Naples
Correspondence to: Luigi Greco, Professor of Medicine, Chief, European Laboratory for Food Induced Diseases, Federico II University of Naples, 80131 Naples, Italy.
Telephone: +39-081-7463275 Fax: +39-081-7462375
Received: March 19, 2011
Revised: June 15, 2011
Accepted: June 22, 2011
Published online: December 7, 2011

AIM: To estimate the burden of undiagnosed celiac disease (CD) in the Mediterranean area in terms of morbidity, mortality and health cost.

METHODS: For statistics regarding the population of each country in the Mediterranean area, we accessed authoritative international sources (World Bank, World Health Organization and United Nations). The prevalence of CD was obtained for most countries from published reports. An overall prevalence rate of 1% cases/total population was finally estimated to represent the frequency of the disease in the area, since none of the available confidence intervals of the reported rates significantly excluded this rate. The distribution of symptoms and complications was obtained from reliable reports in the same cohort. A standardized mortality rate of 1.8 was obtained from recent reports. Crude health cost was estimated for the years between symptoms and diagnosis for adults and children, and was standardized for purchasing power parity to account for the different economic profiles amongst Mediterranean countries.

RESULTS: In the next 10 years, the Mediterranean area will have about half a billion inhabitants, of which 120 million will be children. The projected number of CD diagnoses in 2020 is 5 million cases (1 million celiac children), with a relative increase of 11% compared to 2010. Based on the 2010 rate, there will be about 550 000 symptomatic adults and about 240 000 sick children: 85% of the symptomatic patients will suffer from gastrointestinal complaints, 40% are likely to have anemia, 30% will likely have osteopenia, 20% of children will have short stature, and 10% will have abnormal liver enzymes. The estimated standardized medical costs for symptomatic celiac patients during the delay between symptom onset and diagnosis (mean 6 years for adults, 2 years for children) will be about €4 billion (€387 million for children) over the next 10 years. A delay in diagnosis is expected to increase mortality: about 600 000 celiac patients will die in the next 10 years, with an excess of 44.4% vs age- and sex-matched controls.

CONCLUSION: In the near future, the burden of CD will increase tremendously. Few Mediterranean countries are able to face this expanding epidemic alone.

Keywords: Pediatric, Celiac disease, Short stature, Anemia, Osteopenia, Purchasing power parity, Standardized mortality rate, Mediterranean area