title: Prevalence of celiac disease in Germany: a prospective follow-up study.
abstract: OBJECTIVE
  To determine the prevalence of celiac disease in a randomly selected population sample.
  
  
  METHODS
  A total of 2157 subjects (1036 males; 1121 females) participating in a population-based cross-sectional study underwent laboratory testing for tissue transglutaminase and antibodies to immunoglobulin A, endomysium and antigliadin. In a second step, all subjects who had been examined serologically were surveyed using a questionnaire that included questions specific to celiac disease. Subjects with positive antibody titers and those with histories positive for celiac disease then underwent biopsy. At the first follow up, antibody titers were again determined in these subjects and subjects were questioned regarding symptoms specific for celiac disease and disorders associated with celiac disease. The second follow up consisted of a telephone interview with subjects positive for celiac disease.
  
  
  RESULTS
  Antibody tests consistent with celiac disease were reported in eight subjects, corresponding to an overall prevalence of 1:270 (8/2157). The prevalence among women was 1:224 and 1:518 in men. Classical symptoms were observed in 62.5% of subjects. Atypical celiac disease was present in 25.0%, and transient celiac disease in 12.5%. False-negative test results were returned in three subjects. This yields a sensitivity and specificity of 62.5% and 50.0%, respectively, for tissue transglutaminase immunoglobulin-A antibody; of 62.5% and 71.4% respectively, for endomysium antibody; and of 62.5% and 71.4%, respectively, for antigliadin antibody.
  
  
  CONCLUSIONS
  The prevalence rate in our collective lies within the middle tertile of comparable studies in Europe. The use of a single antibody test for screening purposes must be called into question.
authors.affiliation: Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany. wolfgang.kratzer@uniklinik-ulm.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kratzer
authors.forename: Monika
authors.initials: M
authors.lastname: Kibele
authors.forename: Atilla
authors.initials: A
authors.lastname: Akinli
authors.forename: Marc
authors.initials: M
authors.lastname: Porzner
authors.forename: Bernhard O
authors.initials: BO
authors.lastname: Boehm
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenig
authors.forename: Suemeyra
authors.initials: S
authors.lastname: Oeztuerk
authors.forename: Richard A
authors.initials: RA
authors.lastname: Mason
authors.forename: Ren
authors.initials: R
authors.lastname: Mao
authors.forename: Mark H
authors.initials: MH
authors.lastname: Haenle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D019204:GTP-Binding Proteins; D005858:Germany / Q000453:epidemiology; D005903:Gliadin / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D015203:Reproducibility of Results; D012698:Serologic Tests; D011795:Surveys and Questionnaires; D011503:Transglutaminases / Q000276:immunology; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D006680:HLA Antigens; D007070:Immunoglobulin A; D005903:Gliadin; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
keywords: Celiac disease; Cross-sectional study; Prevalence; Screening; Serology