Prevalence of Celiac Disease among Children in Finland
Markku Mäki, M.D., Ph.D., Kirsi Mustalahti, M.D., Jorma Kokkonen, M.D., Ph.D., Petri Kulmala, M.D., Ph.D., Mila Haapalahti, M.Sc., Tuomo Karttunen, M.D., Jorma Ilonen, M.D., Ph.D., Kaija Laurila, M.Sc., Ingrid Dahlbom, M.Sc., Tony Hansson, Ph.D., Peter Höpfl, Ph.D., and Mikael Knip, M.D., Ph.D.
Background Wheat, rye, and barley proteins induce celiac disease,an autoimmune type of gastrointestinal disorder, in geneticallysusceptible persons. Because the disease may be underdiagnosed,we estimated the prevalence of the disease and tested the hypothesisthat assays for serum autoantibodies can be used to detect untreatedceliac disease and that positive findings correlate with specificHLA haplotypes.
Methods Serum samples were collected from 3654 students (agerange, 7 to 16 years) in 1994 and screened in 2001 for endomysialand tissue transglutaminase antibodies. HLA typing was alsoperformed on stored blood samples. All antibody-positive subjectswere asked to undergo small-bowel biopsy in 2001.
Results Of the 3654 subjects, 56 (1.5 percent) had positiveantibody tests, as determined in 2001. Results of the two antibodytests were highly concordant. As of 1994, none of the subjectshad received a clinical diagnosis of celiac disease, but 10who had positive tests for both antibodies in serum obtainedin 1994 received the diagnosis between 1994 and 2001. Of the36 other subjects with positive antibody assays who agreed toundergo biopsy in 2001, 27 had evidence of celiac disease onbiopsy. Thus, the estimated biopsy-proved prevalence was 1 casein 99 children. All but two of the antibody-positive subjectshad either the HLA-DQ2 or the HLA-DQ8 haplotype. The prevalenceof the combination of antibody positivity and an HLA haplotypeassociated with celiac disease was 1 in 67.
Conclusions The presence of serum tissue transglutaminase andendomysial autoantibodies is predictive of small-bowel abnormalitiesindicative of celiac disease. There is a good correlation betweenautoantibody positivity and specific HLA haplotypes. We estimatethat the prevalence of celiac disease among Finnish schoolchildrenis at least 1 case in 99 children.
Source Information
From the Pediatric Research Center, Medical School, University of Tampere, Tampere, Finland (M.M., K.M., K.L.); the Department of Pediatrics, Tampere University Hospital, Tampere, Finland (M.M., K.M., M.K.); the Departments of Pediatrics (J.K., P.K., M.H.) and Pathology (T.K.), Oulu University Hospital, Oulu, Finland; Turku Immunology Center and Department of Virology, University of Turku, Turku, Finland (J.I.); Pharmacia Diagnostics, Uppsala, Sweden (I.D., T.H.); Pharmacia Diagnostics, Freiburg, Germany (P.H.); and the Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland (M.K.).
Address reprint requests to Professor Mäki at the Celiac Disease Study Group, Pediatric Research Center, Medical School, Bldg. FM3, FIN-33014 University of Tampere, Tampere, Finland, or at markku.maki{at}uta.fi.
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