Epidemiological, clinical and histopathologic characteristics of celiac disease: results of a case-finding population-based program in an Italian community.
OBJECTIVE
Celiac disease (CD) is underdiagnosed mainly because of lack of awareness of its heterogeneous clinical presentation. The Center for Surveillance and Control of Celiac Disease (CCD) was set up in June 2000 in the province of Brescia, Northern Italy (1,016,426) inhabitants to enhance case-finding, to standardize diagnostic criteria and to collect epidemiological data.


METHODS
The CCD has prompted an educational "celiac awareness program" in the primary-care setting focusing on selective serological screening of high-risk groups, and has reviewed by standardized criteria all diagnoses made in the province since 1984.


RESULTS
A total of 1437 CD patients have been identified by the CCD, 508 of them diagnosed after June 2000 during the 3 years of activity of the Center (M:F 2:1). Annual incidence was 0.11/1000 before and increased to 0.17/1000 during CCD activity, and this increase was greater for adult (from 0.07/1000 to 0.12/1000) than for pediatric CD (from 0.04/1000 to 0.05/1000). Mean age at diagnosis also increased from 20.2+/-17.7 years to 27.2+/-19.3 years (p<0.0001) as did the proportion of asymptomatic patients (8% versus 15%) before and during CCD activity. There was a linear trend towards increasing proportions of symptomatic patients with increasing severity of histopathologic lesions (p<0.03).


CONCLUSIONS
Our results indicate that educational programs promoting serological screening of CD in high-risk groups are effective for case-finding in large communities, particularly among the adult population, and suggest that primary-care doctors caring for adults should be particularly targeted by "celiac awareness programs".
Lanzini
Alberto
A
Department of Gastroenterology, Spedali Civili and University of Brescia, Brescia, Italy. lanzini@meb.unibs.it
Villanacci
Vincenzo
V
Apillan
Nazzaren
N
Lanzarotto
Francesco
F
Pirali
Francesco
F
Amato
Massimo
M
Indelicato
Anna
A
Scarcella
Carmelo
C
Donato
Francesco
F
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000032:analysis; D001706:Biopsy; D002446:Celiac Disease / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D007074:Immunoglobulin G / Q000276:immunology; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D012189:Retrospective Studies; D012424:Rural Population; D012720:Severity of Illness Index; D017678:Sex Distribution
D000888:Antibodies, Anti-Idiotypic; D007070:Immunoglobulin A; D007074:Immunoglobulin G