Coeliac disease in The Netherlands
The prevalence of adult coeliac disease in The Netherlands was studied in the Dutch Coeliac Disease Society and in blood donors but not in the general population. We therefore studied the prevalence of recognized and unrecognized coeliac disease in a large cohort, representative of the adult Dutch general population. Blood samples were available for anonymous research, as well as data on dietary habits, self-reported physical characteristics, health problems, quality of life and socio-economic circumstances.
Subjects included 50,760 individuals who had previously participated in two large population-based studies on health status in relation to lifestyle factors. Recognized coeliac disease was studied in all subjects by identification of self-reported adherence to a gluten-free diet and subsequent confirmation of the diagnosis of coeliac disease. Unrecognized coeliac disease was studied in a random sample of 1440 out of the 50,760 subjects through serologic screening and human lymphocyte antigen (HLA) typing.
The prevalence of recognized coeliac disease was 0.016% (95% confidence interval 0.008-0.031) and of unrecognized coeliac disease 0.35% (95% confidence interval 0.15-0.81). Menarcheal age was higher in women with recognized coeliac disease than in women without coeliac disease.
The prevalence of adult recognized coeliac disease in The Netherlands is one of the lowest in Europe, while the prevalence of unrecognized coeliac disease is comparable with that in other European countries. Adult coeliac disease is strongly under diagnosed in The Netherlands. The higher menarcheal age in women with recognized coeliac disease may be explained by diagnostic delay.
Available from: Kalliopi Zachou
- "Large-scale screening studies have shown a CD prevalence of nearly 0.5–1.0% in both adults and children   , but a considerable number of patients remain unrecognized and thus untreated. This is partly due to the variable clinical presentation of CD, which can vary from a typical malabsorption syndrome or extraintestinal manifestations to a clinically silent disease, often detected by serological screening of those subjects at risk. "
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ABSTRACT: IgA antibodies against tissue-transglutaminase (anti-tTG-IgA) and IgA and IgG antibodies against deamidated gliadin peptides (anti-DGP-IgA and anti-DGP-IgG) are considered specific for celiac disease (CD) whereas, patients with chronic liver disorders have an increased risk of latent CD development. We investigated the prevalence and clinical significance of anti-DGP-IgA, anti-DGP-IgG and anti-tTG-IgA in a large cohort of patients with chronic liver diseases.
668 patients without gastrointestinal symptoms (426 viral hepatitis, 94 autoimmune liver diseases, 61 alcoholic disease, 46 non-alcoholic fatty liver disease, 41 with other liver disorders) were investigated by ELISAs (INOVA Diagnostics). Patients positive for at least one autoantibody invited for a small-intestinal biopsy and HLA-DQ typing.
Anti-DGP-IgA were detected in 8.5%, anti-DGP-IgG in only one (0.15%, P<0.001) and anti-tTG-IgA in 5.8% of patients (P=0.05). Fifty-two were anti-DGP-IgA(+)/anti-tTG-IgA(-), 34 anti-DGP-IgA(-)/anti-tTG-IgA(+), and 5 anti-DGP-IgA(+)/anti-tTG-IgA(+). Anti-DGP-IgA positivity was associated with older age (P<0.05), cirrhosis (P<0.05) and increased IgA (P<0.05) whereas, anti-tTG-IgA only with cirrhosis (P<0.05). Histology and HLA-typing compatible with CD was revealed in 4/14 anti-DGP-IgA(+)/anti-tTG-IgA(-), 0/13 anti-DGP-IgA(-)/anti-tTG-IgA(+) and 2/2 anti-DGP-IgA(+)/anti-tTG-IgA(+). All 6 patients diagnosed with CD were anti-DGP-IgA(+) and only 2 anti-tTG-IgA(+).
Although a significant number of patients had detectable CD-related autoantibodies, anti-DGP-IgA test seems better than anti-tTG-IgA for unmasking occult forms of CD in patients with chronic liver disorders. The known good performance for CD diagnosis of anti-DGP-IgG test was not confirmed in this specific group of patients.
Available from: ncbi.nlm.nih.gov
- "The prevalence studies included in this analysis were limited to studies in which the date used to define prevalence was within the last 20 years (1989–2008). For diseases and areas in which Addison 18 11–14 UK, Italy, Norway    Alopecia 21 1700 US  Celiac disease 50 180–350 Greece, Netherlands   140–280 Iran, Tunisia    740–1000 Iceland, Italy   470–600 Brazil, Argentina   1900 Finland  900 Turkey  Crohn disease 225 28–53 Bosnia-Herzegovina, Hungary   6–53 Puerto Rico, Malaysia, Lebanon    96–201 US, Spain, Denmark, New Zealand       113 Israel  Ulcerative colitis 378 143–294 US, Hungary, Denmark, New Zealand [19,21–23,25,26] 6 Lebanon  102 Puerto Rico  Diabetes (Type 1) All ages 946 118 Lithuania  All ages 340–570 UK, Sweden, Australia    Ages < 20 87–120 Spain, Germany   31 Bahamas  Ages < 20 227–355 US, New Zealand   110–270 Kuwait, Saudi Arabia   Ages < 20 70 US-American Indian  Liver – Chronic active hepatitis 45 11–17 Spain, Sweden, Norway    3–8 Singapore  36 US-Alaska Natives  Liver – Primary biliary cirrhosis 12 15–40 Norway, Finland, Spain, UK, [45,48–51] 4–18 Israel  4–20 US, Australia  Thyroid – Hyper 629 500 US  20 Iran  626 UK  Thyroid – Hypo 62 300 US  350 Iran  2980 UK  Multiple sclerosis 182 177–358 US, Canada     4–20 Colombia, Brazil, Argentina    100 Canada-First Nations  13 Japan  121–200 Italy, Greece, France, Ireland          11–62 Israel, Kuwait, Jordan, Iran     46 Norway  101 Turkey  50 Portugal, New Zealand  Myasthenia gravis 18 8–15 Greece, Estonia, Croatia    3 Colombia   Netherlands, Sweden, UK    "
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ABSTRACT: Previous studies have estimated a prevalence of a broad grouping of autoimmune diseases of 3.2%, based on literature review of studies published between 1965 and 1995, and 5.3%, based on national hospitalization registry data in Denmark. We examine more recent studies pertaining to the prevalence of 29 autoimmune diseases, and use these data to correct for the underascertainment of some diseases in the hospitalization registry data. This analysis results in an estimated prevalence of 7.6-9.4%, depending on the size of the correction factor used. The rates for most diseases for which data are available from many geographic regions span overlapping ranges. We also review studies of the co-occurrence of diseases within individuals and within families, focusing on specific pairs of diseases to better distinguish patterns that may result in insights pertaining to shared etiological pathways. Overall, data support a tendency for autoimmune diseases to co-occur at greater than expected rates within proband patients and their families, but this does not appear to be a uniform phenomenon across all diseases. Multiple sclerosis and rheumatoid arthritis is one disease pair that appears to have a decreased chance of coexistence.
Available from: leidenuniv.nl
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ABSTRACT: Celiac disease is an intolerance to dietary gluten in genetically predisposed individuals, leading to alterations of the small bowel mucosa. The treatment consists of a life-long, gluten-free diet. The aims of this thesis were to measure some of the environmental factors considered to play a role in the prevention of celiac disease. For that purpose breast milk was studied on the presence of glutenpeptides and a food frequency questionnaire was developed and validated to quantify gluten intake in young infants. Furthermore, the current treatment at different ages and the ability to develop gluten tolerance were studied. It became clear that the nutrient intake of adolescents on a gluten-free diet can be ameliorated, and that the rather new naturally gluten-free cereal tef is frequently used by Dutch celiac patients and a wide majority of them can consume tef without clinical symptoms. Therefore tef can be a valuable addition to their diet. Although celiac disease is considered to be a permanent condition, we made an attempt to find patients who have become tolerant to gluten. We found 2 of these exceptional patients and found that one of them had HLA-typing different from HLA-DQ2/DQ8, suggesting that genetic factors may play a role in the development of tolerance. The underlying mechanisms leading to prevention, disease development or tolerance to gluten are complex and need to be further studied.
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