title: Detection of adult celiac disease with duodenal screening biopsies over a 30-year period.
abstract: BACKGROUND
  Serological studies suggest that celiac disease may be present in approximately 0.5% to 1% of the North American population. Screening data based on small intestinal biopsy performed during routine endoscopic evaluations are not available.
  
  
  METHODS
  Patients referred between January 1982 and December 2011 for evaluation of gastrointestinal symptoms and requiring elective investigative upper endoscopic evaluation underwent duodenal biopsies to determine whether changes of adult celiac disease were present.
  
  
  RESULTS
  A total of 9665 patients, including 4008 (41.5%) males and 5657 (68.5%) females, underwent elective endoscopies and duodenal biopsies. Of these, 234 (2.4%) exhibited changes of celiac disease including 73 males (1.8%) and 161 females (2.8%). During the first 20 years, the number of biopsy-positive patients in five-year intervals progressively decreased and, subsequently, during the next 10 years, the number progressively increased.
  
  
  CONCLUSIONS
  Celiac disease is far more common in specialist practice than has been suggested in the evaluation of healthy populations using serological screening studies. Endoscopic duodenal biopsy is an important method of identifying underlying celiac disease and should be routinely considered in all patients undergoing an elective endoscopic evaluation. Noninherited factors, possibly environmental, may play a role in the appearance of biopsy-defined celiac disease and alter detection over time.
authors.affiliation: Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, British Columbia, Canada. hugfree@shaw.ca
authors.forename: Hugh James
authors.initials: HJ
authors.lastname: Freeman
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D004386:Duodenum / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D013997:Time Factors