Population screening for coeliac disease in a low prevalence area in Italy.
OBJECTIVE
A screening program was proposed for the village of Carcare (population 5700), located in a region of Italy with an apparently low prevalence of coeliac disease (CD): only 1 patient diagnosed out of 2557 inhabitants. The study group comprised 1002 individuals (568 F, 434 M, age range 13-90 years) recruited from blood donors, secondary school pupils and people referred to the local outpatient facilities for routine blood chemistry.


METHODS
Total IgA, IgA anti-tissue transglutaminase (tTG) (ELISA, recombinant human antigen) and IgA antiendomysium (EMA) (IFI, umbilical cord substrate) antibodies were measured in the serum of all participants. All patients with IgA deficiency were investigated for IgG tTG antibodies, and in the case of disagreement between tTG and EMA, they were typed for HLA DQ2-DQ8 haplotypes.


RESULTS
Thirteen subjects were positive and 988 negative for autoantibodies (3/988 had IgA deficiency). One serum sample was positive for tTG antibodies but negative for EMA. Ten out of 13 positive subjects consented to undergo duodenal biopsy, which invariably produced evidence of CD despite the absence of clinical signs/symptoms. A post-diagnostic clinical investigation provided evidence showing mild iron deficiency (4 subjects) and osteoporosis (2 subjects). After counselling, all subjects accepted a gluten-free diet.


CONCLUSIONS
The prevalence of CD in the study group was 1:100 (1.0%; 95% CI: 0.5-1.8%): this indicates that CD is largely underdiagnosed in Carcare. Our results suggest that the low prevalence of CD observed in some regions is likely to be due to underdiagnosis.
Menardo
Giorgio
G
Medicina Interna II ASL2 Savona, Ospedale S.Paolo, Savona, Italy.
Brizzolara
Renata
R
Bonassi
Stefano
S
Marchetti
Alessandro
A
Dante
Gian Luigi
GL
Pistone
Cristina
C
Marenco
Donatella
D
Rabellino
Viviana
V
Buscaglia
Sandra
S
Scarso
Rita
R
Murialdo
Mauro
M
Venturino
Ezio
E
Marino
Carla Enrica
CE
Descalzi
Desideria
D
Minetti
Franca
F
Bagnasco
Marcello
M
Pesce
Giampaola
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology; D004386:Duodenum / Q000473:pathology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007558:Italy / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D011503:Transglutaminases / Q000097:blood
D001323:Autoantibodies; D007070:Immunoglobulin A; D011503:Transglutaminases