Less Hidden Celiac Disease But Increased Gluten Avoidance Without a Diagnosis in the United States

Abstract

Objective To investigate the trends of diagnosed celiac disease (CD), undiagnosed CD, and people without CD avoiding gluten (PWAG) in the civilian non-institutionalized US population from 2009 to 2014. Patients and Methods We studied the occurrence of CD and PWAG in the 2009–2014 National Health and Nutrition Examination Surveys (NHANES). The sera of all participants 6 years and older from NHANES 2009–2014 were tested for CD serology at Mayo Clinic. Participants were interviewed about a diagnosis of CD and the use of a gluten-free diet (GFD). The design effects of the survey and sample weights were incorporated in all statistical analyses. Results In the US general population, the prevalence of CD did not significantly change from 2009–2010 [0.7%, 95% CI (0.6–0.8)] to 2011–2012 [0.8%, 95% CI (0.4–1.2)] to 2013–2014 [0.7%, 95% CI (0.3–1.0)]. However, the prevalence of undiagnosed CD decreased from 0.6% in 2009–2010 to 0.3% in 2013–2014. In contrast, the prevalence of PWAG significantly increased from 0.5% (95% CI, 0.2–0.9) in 2009–2010 to 1.0% (95% CI, 0.6–1.4) in 2011–2012 to 1.7% (95% CI, 1.1–2.4) in 2013–2014 (P for trend = .005). Conclusion While the overall prevalence of CD remained stable between 2009 and 2014, the proportion CD that is hidden significantly decreased. Moreover, the prevalence of individuals without CD but following a GFD markedly increased between 2009 and 2014. Long-term health consequences of GFD warrant further investigation.

Elevated serum interleukin‐2 after gluten correlates with symptoms and is a potential diagnostic biomarker for coeliac disease

“…6 There has been widespread adoption of gluten-free diet by patients who have not been medically evaluated, but may have coeliac disease. 7,8 Diagnostic tests for coeliac disease, serology and duodenal histology normalise with strict gluten exclusion. 6 Genetic testing can rule out coeliac disease in patients on gluten-free diet, but its clinical utility is limited because of the high prevalence of coeliacassociated HLA-DQ genotypes.…”

Celiac Disease Treatment: Is It the Chicken or the Egg Yolk?

“…Once the safety and efficacy of AGY are confirmed in a larger cohort, it would then be interesting to investigate whether this preparation could be used for other glutenrelated disorders in light of the remarkable increase in the use of a gluten-free diet outside of CD [1], in particular for subjects affected by the still vague entity termed non-celiac gluten sensitivity (NCGS) or wheat intolerance syndrome (WIS) [10], characterized by a wide range of symptoms elicited by gluten that may be ''dose-related.'' We could in fact hypothesize that neutralizing even a fraction of the ingested gliadin could be beneficial in terms of reducing clinical symptoms in the subset of these subjects that truly react to gluten.…”

“…Its incidence, like that of many other autoimmune disorders, is apparently increasing over time, although recently, it may possibly be plateauing, at least in the USA [1]. From a pathogenic standpoint, CD is the result of a complex inflammatory immune response arising in the small intestinal mucosa of genetically susceptible individuals upon the ingestion of dietary gluten.…”

Self-Reported Dietary Adherence, Disease-Specific Symptoms, and Quality of Life are Associated with Healthcare Provider Follow-Up in Celiac Disease

“…The prevalence of CeD is estimated to be approximately 1% in most Western countries, although many individuals with CeD remain undiagnosed [2,3]. Currently, the only treatment for CeD is a strict, lifelong gluten-free diet (GFD).…”