Original Article
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World J Gastroenterol. May 7, 2013; 19(17): 2612-2620
Published online May 7, 2013. doi: 10.3748/wjg.v19.i17.2612
Prevalence of celiac disease in Germany: A prospective follow-up study
Wolfgang Kratzer, Monika Kibele, Atilla Akinli, Marc Porzner, Bernhard O Boehm, Wolfgang Koenig, Suemeyra Oeztuerk, Richard A Mason, Ren Mao, Mark H Haenle
Wolfgang Kratzer, Monika Kibele, Atilla Akinli, Marc Porzner, Bernhard O Boehm, Suemeyra Oeztuerk, Mark H Haenle, Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany
Wolfgang Koenig, Department of Internal Medicine II, University Hospital Ulm, 89081 Ulm, Germany
Richard A Mason, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH 44106, United States
Ren Mao, Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
Author contributions: Kratzer W and Kibele M contributed equally to this work; Kratzer W, Kibele M, Boehm OB and Haenle MM designed the research; Kratzer W, Kibele M, Mao R, Oeztuerk S and Mason RA performed the research; Porzner M, Akinli A, Boehm BO and Koenig W contributed to new reagents and analytic tools; Kratzer W, Kibele M, Oeztuerk S and Haenle MM analyzed the data; Kratzer W, Kibele M, Oeztuerk S and Mason RA wrote the paper; all authors approved the final version.
Correspondence to: Wolfgang Kratzer, MD, Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany. wolfgang.kratzer@uniklinik-ulm.de
Telephone: +49-731-50044730 Fax: +49-731-50044620
Received: October 31, 2012
Revised: December 18, 2012
Accepted: February 5, 2013
Published online: May 7, 2013
Abstract

AIM: To determine the prevalence of celiac disease in a randomly selected population sample.

METHODS: A total of 2157 subjects (1036 males; 1121 females) participating in a population-based cross-sectional study underwent laboratory testing for tissue transglutaminase and antibodies to immunoglobulin A, endomysium and antigliadin. In a second step, all subjects who had been examined serologically were surveyed using a questionnaire that included questions specific to celiac disease. Subjects with positive antibody titers and those with histories positive for celiac disease then underwent biopsy. At the first follow up, antibody titers were again determined in these subjects and subjects were questioned regarding symptoms specific for celiac disease and disorders associated with celiac disease. The second follow up consisted of a telephone interview with subjects positive for celiac disease.

RESULTS: Antibody tests consistent with celiac disease were reported in eight subjects, corresponding to an overall prevalence of 1:270 (8/2157). The prevalence among women was 1:224 and 1:518 in men. Classical symptoms were observed in 62.5% of subjects. Atypical celiac disease was present in 25.0%, and transient celiac disease in 12.5%. False-negative test results were returned in three subjects. This yields a sensitivity and specificity of 62.5% and 50.0%, respectively, for tissue transglutaminase immunoglobulin-A antibody; of 62.5% and 71.4% respectively, for endomysium antibody; and of 62.5% and 71.4%, respectively, for antigliadin antibody.

CONCLUSION: The prevalence rate in our collective lies within the middle tertile of comparable studies in Europe. The use of a single antibody test for screening purposes must be called into question.

Keywords: Cross-sectional study, Celiac disease, Screening, Prevalence, Serology

Core tip: Only limited data on the prevalence of celiac disease in the adult European population are available. Aim of the study was to determine the prevalence of celiac disease in a randomly selected population sample in Germany and to assess the sensitivity and specificity of antibody tests. Eight of 2157 (1:270) subjects tested positive for celiac disease. Tissue transglutaminase immunoglobulin-A antibody yielded a sensitivity of 62.5% (specifity 50.0%), endomysium antibody of 62.5% (71.4%) and antigliadin antibody of 62.5% (71.4%). The prevalence rate lies within comparable European study results. The use of a single antibody test for screening purposes must be questioned.