title: The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school-age subjects.
abstract: BACKGROUND
  Recent studies suggest that coeliac disease (CD) is one of the commonest, life-long disorders in Italy. The aims of this multicentre work were: (a) to establish the prevalence of CD on a nationwide basis; and (b) to characterize the CD clinical spectrum in Italy.
  
  
  METHODS
  Fifteen centres screened 17,201 students aged 6-15 years (68.6% of the eligible population) by the combined determination of serum IgG- and IgA-antigliadin antibody (AGA) test; 1289 (7.5%) were IgG and/or IgA-AGA positive and were recalled for the second-level investigation; 111 of them met the criteria for the intestinal biopsy: IgA-AGA positivity and/or AEA positivity or IgG-AGA positivity plus serum IgA deficiency.
  
  
  RESULTS
  Intestinal biopsy was performed on 98 of the 111 subjects. CD was diagnosed in 82 subjects (75 biopsy proven, 7 not biopsied but with associated AGA and AEA positivity). Most of the screening-detected coeliac patients showed low-grade intensity illness often associated with decreased psychophysical well-being. There were two AEA negative cases with associated CD and IgA deficiency. The prevalence of undiagnosed CD was 4.77 x 1000 (95% CI 3.79-5.91), 1 in 210 subjects. The overall prevalence of CD, including known CD cases, was 5.44 x 1000 (95% CI 4.57-6.44), 1 in 184 subjects. The ratio of known to undiagnosed CD cases was 1 in 7.
  
  
  CONCLUSIONS
  These findings confirm that, in Italy, CD is one of the most common chronic disorders showing a wide and heterogeneous clinical spectrum. Most CD cases remain undiagnosed unless actively searched.
authors.affiliation: Department of Pediatrics, University of Ancona, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Catassi
authors.forename: E
authors.initials: E
authors.lastname: Fabiani
authors.forename: I M
authors.initials: IM
authors.lastname: Rätsch
authors.forename: G V
authors.initials: GV
authors.lastname: Coppa
authors.forename: P L
authors.initials: PL
authors.lastname: Giorgi
authors.forename: R
authors.initials: R
authors.lastname: Pierdomenico
authors.forename: S
authors.initials: S
authors.lastname: Alessandrini
authors.forename: G
authors.initials: G
authors.lastname: Iwanejko
authors.forename: R
authors.initials: R
authors.lastname: Domenici
authors.forename: E
authors.initials: E
authors.lastname: Mei
authors.forename: A
authors.initials: A
authors.lastname: Miano
authors.forename: M
authors.initials: M
authors.lastname: Marani
authors.forename: G
authors.initials: G
authors.lastname: Bottaro
authors.forename: M
authors.initials: M
authors.lastname: Spina
authors.forename: M
authors.initials: M
authors.lastname: Dotti
authors.forename: A
authors.initials: A
authors.lastname: Montanelli
authors.forename: M
authors.initials: M
authors.lastname: Barbato
authors.forename: F
authors.initials: F
authors.lastname: Viola
authors.forename: R
authors.initials: R
authors.lastname: Lazzari
authors.forename: M
authors.initials: M
authors.lastname: Vallini
authors.forename: G
authors.initials: G
authors.lastname: Guariso
authors.forename: M
authors.initials: M
authors.lastname: Plebani
authors.forename: F
authors.initials: F
authors.lastname: Cataldo
authors.forename: G
authors.initials: G
authors.lastname: Traverso
authors.forename: A
authors.initials: A
authors.lastname: Ventura
mesh_terms: D000293:Adolescent; D000906:Antibodies / Q000097:blood / Q000276:immunology; D015551:Autoimmunity; D015415:Biomarkers / Q000097:blood; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005903:Gliadin / Q000276:immunology; D006681:HLA-D Antigens / Q000235:genetics; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood / Q000276:immunology; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007558:Italy; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015995:Prevalence; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000379:methods
chemical_list: D000906:Antibodies; D015415:Biomarkers; D006681:HLA-D Antigens; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005903:Gliadin