Celiac disease in the East and the West: Bridging the gaps between the guidelines and their implementation in daily practice is mandatory

Dhawan, Anju; Agarwal, Ashish; Mulder, Chris J.; Makharia, Govind

doi:10.1007/s12664-019-00970-7

Cited by 8 publications

(7 citation statements)

References 48 publications

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“…In agreement with other authors[ 29 , 30 ], several factors (that vary by country and regions) can contribute to hamper CD diagnosis and, thus, the estimation of its epidemiological burden. Overall, these factors include poor disease awareness among physicians and/or patients, limited access to diagnostic resources (because of economic and/or organizational and/or geographical reasons), inappropriate use or interpretation of the available serological tests, absence of standardized diagnostic and endoscopic protocols, and insufficient expertise in histopathological interpretation.…”

Section: Discussionsupporting

confidence: 92%

Celiac Disease in Asia beyond the Middle East and Indian subcontinent: Epidemiological burden and diagnostic barriers

Poddighe

Abdukhakimova

2021

WJG

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Celiac Disease (CD) had been considered uncommon in Asia for a long time. However, several studies suggested that, in the Indian subcontinent and Middle East countries, CD is present and as prevalent as in Western countries. Outside these Asian regions, the information about the epidemiology of CD is still lacking or largely incomplete for different and variable reasons. Here, we discuss the epidemiological aspects and the diagnostic barriers in several Asian regions including China, Japan, Southeast Asia and Russia/Central Asia. In some of those regions, especially Russia and Central Asia, the prevalence of CD is very likely to be underestimated. Several factors may, to a different extent, contribute to CD underdiagnosis (and, thus, underestimation of its epidemiological burden), including the poor disease awareness among physicians and/or patients, limited access to diagnostic resources, inappropriate use or interpretation of the serological tests, absence of standardized diagnostic and endoscopic protocols, and insufficient expertise in histopathological interpretation.

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Section: Discussionsupporting

confidence: 92%

Celiac Disease in Asia beyond the Middle East and Indian subcontinent: Epidemiological burden and diagnostic barriers

Poddighe

Abdukhakimova

2021

WJG

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“…Especially in Russia and Central Asia, the prevalence of CD is very likely to be underestimated due to poor disease awareness among physicians and/or patients, limited access to diagnostic resources, inappropriate use or interpretation of the serological tests, absence of standardised diagnostic and endoscopic protocols, and insufficient expertise in histopathological interpretation[ 3 ]. Specific guidelines are lacking in these geographical areas[ 79 ]. In addition, the incidence of undiagnosed CD in children can be extremely high[ 80 ].…”

Section: Discussionmentioning

confidence: 99%

Current guidelines for the management of celiac disease: A systematic review with comparative analysis

Raiteri¹,

Granito²,

Giamperoli³

et al. 2022

WJG

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BACKGROUND Wheat and other gluten-containing grains are widely consumed, providing approximately 50% of the caloric intake in both industrialised and developing countries. The widespread diffusion of gluten-containing diets has rapidly led to a sharp increase in celiac disease prevalence. This condition was thought to be very rare outside Europe and relatively ignored by health professionals and the global media. However, in recent years, the discovery of important diagnostic and pathogenic milestones has led to the emergence of celiac disease (CD) from obscurity to global prominence. These modifications have prompted experts worldwide to identify effective strategies for the diagnosis and follow-up of CD. Different scientific societies, mainly from Europe and America, have proposed guidelines based on CD's most recent evidence. AIM To identify the most recent scientific guidelines on CD, aiming to find and critically analyse the main differences. METHODS We performed a database search on PubMed selecting papers published between January 2010 and January 2021 in the English language. PubMed was lastly accessed on 1 March 2021. RESULTS We distinguished guidelines from 7 different scientific societies whose reputation is worldwide recognized and representative of the clinical practice in different geographical regions. Differences were noted in the possibility of a no-biopsy diagnosis, HLA testing, follow-up protocols, and procedures. CONCLUSION We found a relatively high concordance between the guidelines for CD. Important modifications have occurred in the last years, especially about the possibility of a no-biopsy diagnosis in children. Other modifications are expected in the next future and will probably involve the extension of the non-invasive diagnosis to the adult population and the follow-up modalities.

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“…2 The basis of a nonbiopsy approach is based on the evidence of high predictive value of the presence of villous abnormalities if the anti-tTG value is more than 10 times the cut-off value for a positive test. [42][43][44] While serology-based diagnosis is a welcome state, this approach is often misused by physicians, and a diagnosis of CeD is made even at low-titer anti-tTG Ab without duodenal biopsies being performed. 45 Lack of unified guidelines between different societies and for both children and adults leads to confusion and, at times, questioning of the initial diagnosis of CeD by the patient, as well as the physician.…”

Section: Setting Up Of Facility For Diagnosis Of Cedmentioning

confidence: 99%

“…While most national and international societies recommend duodenal biopsies in addition to the celiac‐specific serological tests, the most popular diagnostic criteria for children developed by the European Society of Gastroenterology Hepatology and Nutrition (ESPGHAN) has provided the option of a nonbiopsy approach for those children in whom the anti‐tTG antibody is more than 10‐fold higher 2 . The basis of a nonbiopsy approach is based on the evidence of high predictive value of the presence of villous abnormalities if the anti‐tTG value is more than 10 times the cut‐off value for a positive test 42–44 . While serology‐based diagnosis is a welcome state, this approach is often misused by physicians, and a diagnosis of CeD is made even at low‐titer anti‐tTG Ab without duodenal biopsies being performed 45 .…”

Section: Identification Of Challenges and Suggested Strategiesmentioning

confidence: 99%

Opportunities and challenges in the management of celiac disease in Asia

et al. 2020

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Although once considered uncommon, there is increasing recognition of celiac disease (CeD) in Asia. It is now clear that CeD is a disorder as frequent in certain Asian countries as that in western countries, although it often remains undiagnosed. With increasing awareness and diagnosis, the absolute numbers of celiac patients are expected to increase markedly in Asia. Asia, with 60% of the population of the world, is probably the major "reservoir" of undiagnosed CeD in the world. As Asia has a huge landscape along with highly heterogenous genetic, social, cultural, and nutritional practices, similar heterogeneity is seen in the epidemiology, diagnostic, and therapeutic facilities for CeD in Asia. In this article, we have reviewed the changes in the epidemiology, diagnostics, and management of CeD in Asia and summarized the challenges and opportunities for its emergence in Asia.

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Celiac disease in the East and the West: Bridging the gaps between the guidelines and their implementation in daily practice is mandatory

Cited by 8 publications

References 48 publications

Celiac Disease in Asia beyond the Middle East and Indian subcontinent: Epidemiological burden and diagnostic barriers

Celiac Disease in Asia beyond the Middle East and Indian subcontinent: Epidemiological burden and diagnostic barriers

Current guidelines for the management of celiac disease: A systematic review with comparative analysis

Opportunities and challenges in the management of celiac disease in Asia

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