The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school-age subjects.
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.
Catassi
C
C
Department of Pediatrics, University of Ancona, Italy.
Fabiani
E
E
Rätsch
I M
IM
Coppa
G V
GV
Giorgi
P L
PL
Pierdomenico
R
R
Alessandrini
S
S
Iwanejko
G
G
Domenici
R
R
Mei
E
E
Miano
A
A
Marani
M
M
Bottaro
G
G
Spina
M
M
Dotti
M
M
Montanelli
A
A
Barbato
M
M
Viola
F
F
Lazzari
R
R
Vallini
M
M
Guariso
G
G
Plebani
M
M
Cataldo
F
F
Traverso
G
G
Ventura
A
A
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
D000906:Antibodies; D015415:Biomarkers; D006681:HLA-D Antigens; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005903:Gliadin