Opportunities and challenges in the management of celiac disease in Asia

Agarwal, Ashish; Chauhan, Ashish; Ahuja, Vineet; Makharia, Govind

doi:10.1002/jgh3.12381

Cited by 4 publications

(3 citation statements)

References 50 publications

(100 reference statements)

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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: 91%

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: 91%

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

Poddighe

Abdukhakimova

2021

WJG

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“…Moreover, population specific tests would also lead to minimal delays, judicious resource utilization and better outcomes. 40…”

Section: Diagnosismentioning

confidence: 99%

Presentation and Patterns of Celiac Disease in Indian Subcontinent: A Literature Review

Siddiqui¹,

Agrawal²,

Kumar

et al. 2022

MRAJ

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Gluten, in genetically susceptible individuals induces an immune mediated enteropathy called Celiac disease (CD). It is an established cause of malabsorption, with the worldwide prevalence being 1% in the general population. It is found across all age groups, from infants to the elderly with 20% patients being diagnosed in the seventh decade of life. It has varying clinical presentations ranging from silent asymptomatic forms which are diagnosed during screening to life threatening forms with severe malabsorption to atypical presentations, with the symptom spectrum extending beyond the gastrointestinal tract which are more common in adults. High index of suspicion, robust screening and testing, followed by strict adherence to gluten free diet is a must to curb and cure the disease. Patients tend to face difficulties not only during diagnosis, but also with compliance and availability of a gluten free diet, in addition to significant economic and psychosocial burden, which is more predominant in developing countries. Screening of high-risk groups like first-degree relatives of celiac disease, patients with severe malnutrition, other autoimmune diseases, refractory anaemia and irritable bowel syndrome should be done to enhance case detection. In low middle income countries, judicious resource utilisation takes precedence, hence, tackling a multifactorial disease such as celiac disease becomes challenging. Repeated follow ups, awareness among patients and doctors, encouragement, availability of testing and dietary counselling is necessary for management of the disease in such settings. Improving sanitation and feeding practices may also play role in decreasing incidence, considering childhood GI infections are a well-established risk factor. Increased availability of serological tests (IgA/IgG anti-tTG, anti -EMA and anti-DGP), biopsy, genetic testing and other newer modalities under research have improved the diagnostic accuracy. Poor compliance increases the risk of GI malignancy, non-Hodgkin’s lymphoma, Hepatocellular carcinoma and MALToma. Hence adherence is a must to prevent complications. A wide variety of treatment modalities are being evaluated to bring into force alternative strategies for management. Only providing gluten free diet is often not sufficient for improvement of nutritional status in patients with CD. Hence, micronutrient supplementation should also be encouraged to meet the unmet needs.

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“…It is now time for Asian countries to define the extent of disease and start preparing to handle CD's impending epidemic. Alas, "Rome was not built in a single day," and there is yet a long way to go [60] .…”

Section: Global Prevalence Of Celiac Diseasementioning

confidence: 99%

Celiac disease: An epidemiological condition: Insight on gluten free diet, significance and regulatory recommendations

Kumari¹,

Morya²

2021

Pharma Innovation

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Celiac disease (CD) is a chronic small intestinal immune-mediated enteropathy due to exposure to dietary gluten in genetically vulnerable people. Enteropathy associated to the CD contributes to several macroand micronutrient-related nutrient failures. Celiac disease remains underdiagnosed in several regions, which can result in severe health issues. Non-invasive and inexpensive ways, such as video capsule endoscopy, are currently used for the diagnosis of celiac disease. The aim of this paper is to safe cure for CD by excluding the gluten from the diet, and providing gluten free diet (GFD) according to regulatory recommendations. The diet must not only be free of gluten, but must also be nutritious in order to avoid nutrient, vitamin and mineral deficiency or excess. Hence, we included the GFD, DASH (Dietary Stop Hypertension Appropriations), balanced kidney diet, ketogenic diatribe and low-FODMAP (Fermentable Oligo-, Di-, Mono-saccharides and Polyols) diet, which are forms of medically trained diets. Latest analysis shows that both recently diagnosed and post-GFD CD patients also have nutritional deficiencies. The results of this study reveal the value of a nutritionally healthy diet plan as part of CD treatment. Since celiac disease is a chronic disorder with a variety of symptoms that can be successfully diagnosed and treated to avoid both acute and long-term consequences, it can educate regular clinical practise in all medical disciplines. Patients should live on a completely GFD. A healthy GFD should be focused on a mixture of naturally gluten-free foods and certified gluten-free processed items.

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Opportunities and challenges in the management of celiac disease in Asia

Cited by 4 publications

References 50 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

Presentation and Patterns of Celiac Disease in Indian Subcontinent: A Literature Review

Celiac disease: An epidemiological condition: Insight on gluten free diet, significance and regulatory recommendations

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