title: The celiac iceberg: characterization of the disease in primary schoolchildren.
abstract: OBJECTIVE
  Celiac disease (CD) has a prevalence of 0.55% to 1% in Italy. Identifying CD in schoolchildren to characterize CD iceberg and evaluate the effect of diagnosis in screening-detected children.
  
  
  METHODS
  A total of 7377 5- to 8-year-old children were invited to participate. A total of 5733 salivary samples were collected and tested for anti-transglutaminase antibodies (tTGAb), using a fluid-phase radioimmunoassay. Salivary tTGAb-positive children were analyzed for serum antibodies (anti-endomysium antibodies, radioimmunoassay, and enzyme-linked immunosorbent assay tTGAb). Positive children underwent endoscopy and then started gluten-free diet (GFD) and periodical follow-up.
  
  
  RESULTS
  Forty-six subjects were found salivary tTGAb-positive and 16 border-line. Forty-five of 46 and 5 of 15 of them were also serum antibody-positive. Forty-two children showed duodenal villous atrophy and 1 had only type 1 lesions. Three children started GFD without performing endoscopy. CD prevalence (including 23 previously diagnosed children with CD) was 1.2%. Considering all 65 celiacs in our sample, a silent CD was found in 64%, typical in 28%, atypical in 7%, and potential in 1%. All patients showed strict adherence to GFD, weight and stature increase, and well-being improvement. Eighty-five percent and all but 2 screening-detected children with CD had Italian parents.
  
  
  CONCLUSIONS
  Our sample size, representative of primary schoolchildren of our region, demonstrated that CD prevalence is growing in Italy, with a modified clinical spectrum and iceberg deepness.
authors.affiliation: Department of Paediatrics, La Sapienza University of Rome, Rome, Italy. raffaella.nenna@uniroma1.it
authors.forename: Raffaella
authors.initials: R
authors.lastname: Nenna
authors.forename: Claudio
authors.initials: C
authors.lastname: Tiberti
authors.forename: Laura
authors.initials: L
authors.lastname: Petrarca
authors.forename: Federica
authors.initials: F
authors.lastname: Lucantoni
authors.forename: Maurizio
authors.initials: M
authors.lastname: Mennini
authors.forename: Rita Pia Lara
authors.initials: RP
authors.lastname: Luparia
authors.forename: Francesca
authors.initials: F
authors.lastname: Panimolle
authors.forename: Gerarda
authors.initials: G
authors.lastname: Mastrogiorgio
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Pietropaoli
authors.forename: Fabio Massimo
authors.initials: FM
authors.lastname: Magliocca
authors.forename: Margherita
authors.initials: M
authors.lastname: Bonamico
mesh_terms: D001284:Atrophy; D001323:Autoantibodies / Q000032:analysis; D002446:Celiac Disease / Q000178:diet therapy* / Q000453:epidemiology* / Q000276:immunology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000276:immunology / Q000473:pathology; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D015995:Prevalence; D012463:Saliva / Q000276:immunology; D012720:Severity of Illness Index; D011503:Transglutaminases / Q000037:antagonists & inhibitors
chemical_list: D001323:Autoantibodies; D011503:Transglutaminases