Epidemiology of celiac disease: What are the prevalence, incidence, and progression of celiac disease?

Presented at the NIH Consensus Development Conference on Celiac Disease, June 29–30, 2004.
https://doi.org/10.1053/j.gastro.2005.02.030Get rights and content

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Spectrum of CD

The current model of the natural history of CD (Figure 2) recognizes that, at certain points in time, the disease is not associated with obvious clinical signs and symptoms.

Latent CD precedes diagnosis of CD or follows successful treatment of active disease with a gluten-free diet (GFD). The SBB does not show villous atrophy and crypt hyperplasia, but there are increased γ/δ intraepithelial T cells, higher proportion of dividing epithelial crypt cells,10 and subtle morphometric abnormalities of

Prevalence

The proportion of people in a population who have CD at a specified time (prevalence rate) depends of course on definition of the disease. Figure 3 illustrates prevalence of preclinical (latent), undiagnosed (largely silent), and diagnosed (mostly active) CD in several European and US populations. Although the prevalence of diagnosed CD varied widely among these populations, the estimates of combined undiagnosed and diagnosed (or silent and active) CD were remarkably similar, between 0.7%–2.0%

Incidence

Population-based estimates of the incidence of SBB-confirmed CD in adults vary from 2–13/100,000 per year.4, 35 These rates have to be interpreted with caution because many patients diagnosed as adults likely have had 20–60 years of untreated CD, thus hardly represent truly incident (new) disease.

The recent increase in the incidence rates (Figure 5) is likely due to increasing use of serologic screening leading to diagnosis in milder cases. However, there is a paucity of incidence data that

Progression

Over time, individuals progress from latent to silent or active disease (Figure 2) and can reverse to the latent subclinical state on a strict GFD. It is not entirely clear how strict the GFD has to be in a given patient to avoid symptoms and long-term complications. Although there is growing evidence for a remitting-relapsing pattern of CD autoimmunity in some patients,6, 36 the disease process defined by current serologic and histopathologic techniques is remarkably persistent in the absence

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