Celiac Disease in African-Americans

Columbia University, New York, New York, United States
Digestive Diseases and Sciences (Impact Factor: 2.61). 06/2006; 51(5):1012-5. DOI: 10.1007/s10620-005-9000-5
Source: PubMed


Celiac disease is generally under diagnosed in the United States and it is unclear whether the disease is encountered in ethnic minorities. Our purpose is to describe a case series of African-American patients with celiac disease. Nine (1.3%) African-American patients with celiac disease were identified from a prospectively generated database of 700 patients with biopsy proven celiac disease and seen between 1981 and 2004. Females predominated, with seven, compared to two males. Diarrhea was the presentation in only two patients, while three presented with iron deficiency anemia. One third had at least one autoimmune disease. Compliance with a gluten-free diet, the only medical therapy of this disease, was poor. Only four patients adhered strictly to the diet. Celiac disease occurs in African-Americans and may well be underdiagnosed. Special attention needs to be given to methods that encourage adherence to the diet in minority groups.

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    • "The response to gluten withdrawal in patients is variable, and notably, the clinical, histological, and serological responses often do not occur in parallel. Clinically, a marked symptomatic improvement may occur within several days, whereas mucosal improvement may take up to 2 years [23]. Histological response is characterized by a significant increase in villous size (reduction in villous atrophy), reduction in crypt hyperplasia and finally a reduction in the IEL count. "
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    ABSTRACT: Introduction Coeliac disease (CD) is a common diagnosis among children and adults in Iraq; however, removal of gluten from the diet is essential for patients with CD. The aim of this study, the first such study in Iraq, was to assess the serological and histological recovery profiles of coeliac patients, in both children and adults groups after commencing a gluten-free diet (GFD) for at least 1 year ± 1 month. Material and methods The study group comprised 78 proved coeliac patients (46 children and 32 adults, median age: 15 years, range: 1–66 years) who all agreed to undergo endoscopy in addition to serological assessment before and after treatment. The duodenal biopsies were interpreted histologically according to modified Marsh criteria and the sera were tested for anti-gliadin antibody (AGA), endomysium antibody (EMA) and anti-tissue transglutaminase antibody (tTG). Results Complete histological remission was seen in 29 (63.1%) of 46 treated children CD patients, while only 5 (10.9%) showed Marsh IIIa changes compared with 11 (24%) before GFD. Similarly none of the 32 adults after GFD showed Marsh IIIb and Marsh IIIc compared with 46.9% and 28.1% before treatment respectively (p = 001). Meanwhile, there was strongly significant reduction in AGA, EMA, and tTG antibodies levels (p = 0.00001) following GFD. Conclusions Repeating the duodenal biopsy 1 year ±1 month after diagnosis and starting a GFD supports the routine measurement of using histological findings as a gold standard test to confirm recovery of Iraqi CD patients along with using known coeliac serology antibodies.
    Full-text · Article · May 2014 · Archives of Medical Science
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    • "However, being Caucasian did increase the likelihood of serologic testing. We hypothesize that this may be due to the fact that providers recognize that certain high risk human leukocyte antigen alleles are found more commonly in the Caucasian population, with studies suggesting minority populations such as African Americans comprise only a small percentage of the celiac disease population in the United States [7,8]. Nevertheless, future investigation into whether race and/or ethnicity clearly impact the yield of celiac testing in children with chronic abdominal pain is needed to help guide providers caring for these patients. "
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    ABSTRACT: To determine within one tertiary care center: 1) the variation between providers in testing for celiac disease in children with chronic abdominal pain; 2) the characteristics of those children who were more likely to be tested, and 3) the prevalence of celiac disease in those evaluated. Retrospective review of children with a primary complaint of chronic abdominal pain referred to a tertiary care children's hospital for pediatric gastroenterology evaluation over a 2-year period was conducted. Children with at least two visits and without an identified organic etiology for the pain were included. 160 children were evaluated by 16 pediatric gastroenterologists and one nurse practitioner. Celiac serologic testing was completed in 63 (39.4%) children. There was no significant variance in the frequency of celiac serologic testing between providers. Child age, gender, body mass index, and baseline gastrointestinal symptoms did not predict whether celiac serologic testing occurred, though Caucasians (P < 0.01) were more likely to be tested. Eighty-two (51.3%) children underwent either serologic testing and/or esophagogastroduodenoscopy. Four (4.9%, 95% CI: 1.6-11.3%) of the 82 tested were diagnosed with celiac disease. Though interprovider variation for celiac disease testing in children with chronic abdominal pain did not occur, a large number of these children were not evaluated for celiac disease. Children's race/ethnicity but not their associated gastrointestinal symptoms predicted whether celiac testing was undertaken. In those tested, celiac disease was identified in a higher percentage than that expected in the general population.
    Full-text · Article · Oct 2013 · BMC Gastroenterology
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    • "In Sub-Saharan Africa, CD is rarely reported (Coton et al., 2008; Suliman, 1978). On the other hand, Brar et al. (2006) identified nine cases of American patients among a group of 700 biopsy proven CD patients in USA suggesting that the frequency of CD in Afroderived populations might be underestimated. "
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    ABSTRACT: Celiac disease is an autoimmune disorder that occurs in genetically susceptible individuals in whom the ingestion of dietary gluten induces intestinal mucosa inflammation. Previous studies suggest that celiac disease may either be very rare or underdiagnosed in African and/or African-derived population. Determine the prevalence of celiac disease in Sub-Saharan African-derived Brazilian communities using serological screening. Inhabitants from 10 African-derived communities from Northeastern of Brazil were screened for celiac disease. All sera were tested for endomysial class IgA antibody using indirect immunofluorescence. No positive test for IgA-endomysial was observed in the 860 individuals tested. Our data suggests a low prevalence of celiac disease in African-derived Brazilian populations.
    Full-text · Article · Sep 2012 · American Journal of Human Biology
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