High prevalence of undiagnosed coeliac disease in adults: a Swedish population‐based study

• Published in: Journal of internal medicine Vol. 245; no. 1; pp. 63 - 68
• Main Authors: IVARSSON, A., Persson, L. Å., Juto, P., Peltonen, M., Suhr, O., Hernell, O.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-01-1999; Blackwell Science; Blackwell Publishing Ltd
• Subjects: Adult; adults; Aged; Autoantibodies - blood; Biological and medical sciences; Biopsy; Celiac Disease - diagnosis; Celiac Disease - epidemiology; Celiac Disease - immunology; Celiac Disease/diagnosis/epidemiology/immunology; coeliac disease; Cross-Sectional Studies; Diagnosis, Differential; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gliadin - immunology; Humans; Immunoglobulin A - blood; Immunoglobulin G - blood; Male; Mass Screening - methods; Medical sciences; Middle Aged; Other diseases. Semiology; population‐based; Prevalence; Questionnaires; screening; Seroepidemiologic Studies; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surveys and Questionnaires; Sweden - epidemiology; Sweden; Europe; Human; Immunopathology; Prevalence; Antibody; Coeliac disease; Medical screening; Statistical study; Intestinal malabsorption; Biopsy; Cross sectional study; Gliadin; Digestive diseases; Intestinal disease; Adult; Differential; Diagnosis
• ISSN: 0954-6820; 1365-2796
• DOI: 10.1046/j.1365-2796.1999.00403.x

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Objective. To determine the prevalence of coeliac disease in a population‐based sample of Swedish adults.
Design. Population‐based cross‐sectional study.
Setting. Northern Sweden.
Subjects. A total of 1894 adults (76%) out of 2500 invited, randomly selected from the population register after stratification for age and sex.
Main outcome measures. Prevalence of biopsy verified coeliac disease, symptoms of undiagnosed cases, and results of antiendomysium and antigliadin serum antibody tests.
Results. Coeliac disease was confirmed by intestinal biopsy showing enteropathy in 10 individuals (seven women and three men), corresponding to a prevalence of 5.3 per 1000 (95% CI = 2.5–9.7). The majority of cases (eight out of 10) had not been diagnosed prior to the screening, although many had symptoms compatible with coeliac disease. All individuals with antiendomysium antibody positivity who were subjected to a small intestinal biopsy had enteropathy. Furthermore, all of them also had elevated levels of antigliadin antibodies type IgA and/or IgG.
Conclusions. Coeliac disease is common, albeit mostly undiagnosed, in Swedish adults. It is likely that the situation is no better in other countries. This highlights the importance of keeping coeliac disease in mind, and of promptly investigating individuals with unexplained, even mild, symptoms compatible with the disease. Serological markers, e.g. antigliadin and antiendomysium antibodies, are useful tools within this active case‐finding strategy, although the final diagnosis should be based on an intestinal biopsy demonstrating enteropathy.