How common is celiac disease in Eastern Saudi Arabia?
BACKGROUND
In contrast to its prevalence in Europe, celiac disease (CD) is considered rare in non-Caucasian populations. We aimed to estimate the prevalence of CD in clinically suspicious celiac disease patients and in patients with disorders known to be associated with CD, such as autoimmune diseases, using serological assay for IgA-endomysial antibodies (EMA) on inexpensive human tissue substrate.


METHODS
IgA-endomysial and IgA-reticulin antibodies (ARA) were evaluated by indirect immunofluorescence (IIF) study using human umbilical cord (HUC) and rat tissues, respectively, in the following groups: group 1, 145 patients with clinical suspicion of CD; group 2, 80 with autoimmune diseases; group 3, 20 patients with inflammatory bowel disease (IBD); and group 4, 100 healthy blood donors.


RESULTS
Of the 145 patients with suspected CD (group 1), 11 were EMA positive with or without ARA, giving a serological prevalence of 7.6%. The histological findings of intestinal biopsy were confirmed in six of them, indicating a CD prevalence of 4%. In group 2, two EMA-positive (2.5%) with or without ARA cases were found. Both were from the 18 patients who had autoimmune thyroid disease, indicating an 11% prevalence of EMA in autoimmune thyroid disease. No positive EMA was detected in the 3rd and 4th groups, indicating 100% specificity.


CONCLUSIONS
Our findings showed high prevalence of CD in a reference laboratory setting. This highlights the importance of keeping CD in mind and of promptly investigating suspected individuals. There is also a high prevalence of CD among patients with autoimmune thyroid diseases, and further studies are needed to elucidate the significance of this association. Test for endomysial antibodies using human umbilical cord is an inexpensive, easily available and highly specific tool for identifying patients to undergo biopsy and to screen at-risk groups of patients.
Al Attas
Rabab Ali
RA
Department of Immunopathology, Regional Laboratory and Blood Bank, Ministry of Health, Dammam, Saudi Arabia. drattasrabab@yahoo.com