Celiac Disease Screening in Southern and East Asia

Abstract

Until 1970s, celiac disease (CD) was considered to be an uncommon disease except in Western Europe. The global epidemiology of CD continues to evolve with improvement in the diagnostic tests, simplification of the diagnostic criteria and increase in awareness about the disease. The Asian region is currently at the crossroads of the frontier of knowledge and awareness of CD. In many Asian nations, CD is still considered to be either nonexistent or very rare. A notable exception is India, where CD has been well recognized, especially in the northern part, and 2 population-based studies have revealed a prevalence of 0.3-1.04%. Initial reports from Malaysia, China, Japan and Singapore suggest the existence of CD in these countries. Furthermore, a meta-analysis of the predisposing factors predicts a high probability of occurrence of CD in fair numbers in China. There are no formal reports on CD from Malaysia, Indonesia, Korea, Taiwan and many other nations in this region. With the impending CD epidemic in Asia, there are many challenges. Some of the efforts which are required include determination of prevalence of CD across the region, spreading of awareness among physicians and patients, training of dieticians for proper counseling and supervision of patients, creation of gluten-free food infrastructure in the food supply and creation of patient advocacy organizations. Although the absolute number of patients with CD at present is not very large, this number is expected to increase over the next few years/decades. It is thus appropriate that the medical community across Asia define the extent of the problem and get prepared to handle the impending CD epidemic.

Prevalence of celiac disease in Asia: A systematic review and meta‐analysis

“…The overall prevalence of CD in Asian countries was found to be 0.5%, and there was some variation in the pooled prevalence of CD in Asian countries such as 0.3% in Iran, 0.5% in Turkey, 0.6% in India, and 0.7% in Israel. This difference in the prevalence of CD in Asian countries is likely to be because of differences in the prevalence of HLA‐DQ2/HLA‐DQ8 haplotype in the general population and the pattern of consumption of wheat in these countries . Such difference in the prevalence of CD (from as low as 0.3% in Germany to as high as 2.4% in Finland) was observed in European countries as well .…”

“…The difference in the prevalence of CD in European countries highlights that certain other factors, not so well defined, than HLA haplotype and wheat consumption pattern also play a role in predisposing a population to CD . It is likely that prevalence of CD also varies from country to country in Asia, because of diverse dietary practices and prevalence of predisposing HLA haplotypes in the general population . The prevalence of HLA‐DQ2/HLA‐DQ8 haplotypes varies widely in Asia from more than 20% in countries such as India, Saudi Arabia, Iran, and Israel to 5–20% in countries such as Turkey, Malaysia, and China, and <5% in others such as Japan, Taiwan, and Korea .…”

“…There still are no reports on CD from many Asian countries such as Azerbaijan, Kazakhstan, Turkminstan, Afganistan, Kyrgyzstan, Tajikistan, Cambodia, Myanmar, Vietnam, Mongolia, Nepal, and Bhutan. With widespread availability of CD serological tests, increasing awareness about the disease among gastroenterologists, other specialists, and primary care doctors, and increase in consumption of wheat‐based diet, an increase in the incidence of CD is expected in many Asian countries …”

“…Asia is presently going through this phase. In countries, where CD is supposed to be uncommon and no systematic studies are available, estimating prevalence of CD among at risk‐groups (such as those with chronic diarrhea and type 1 diabetes) could be the first step in those countries . Multicentric collaborative population‐based prevalence studies (national and international) will not only assess the prevalence of CD in Asian countries but also help in understanding the complex interplay between genetic and environmental factors leading to CD.…”

“…Asia is a continent of diverse populations, and Asians differ significantly in their ethnicity, genetic make‐up, and eating practices, the key factors in the pathogenesis of CD . There has been an increase in the awareness about CD in Asia during the past few years as evidenced by increasing number of publications on CD from this region . There however is a paucity of data on the population‐based prevalence of CD from most Asian countries except for a few Middle Eastern countries and India .…”