Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis

doi:10.1016/j.cgh.2017.06.037

Clinical Gastroenterology and Hepatology

Volume 16, Issue 6, June 2018, Pages 823-836.e2

https://doi.org/10.1016/j.cgh.2017.06.037 Get rights and content

Background & Aims

Celiac disease is a major public health problem worldwide. Although initially it was reported from countries with predominant Caucasian populations, it now has been reported from other parts of the world. The exact global prevalence of celiac disease is not known. We conducted a systematic review and meta-analysis to estimate the global prevalence of celiac disease.

Methods

We searched Medline, PubMed, and EMBASE for the keywords celiac disease, celiac, celiac disease, tissue transglutaminase antibody, anti-endomysium antibody, endomysial antibody, and prevalence for studies published from January 1991 through March 2016. Each article was cross-referenced with the words Asia, Europe, Africa, South America, North America, and Australia. The diagnosis of celiac disease was based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. Of 3843 articles, 96 articles were included in the final analysis.

Results

The pooled global prevalence of celiac disease was 1.4% (95% confidence interval, 1.1%–1.7%) in 275,818 individuals, based on positive results from tests for anti–tissue transglutaminase and/or anti-endomysial antibodies (called seroprevalence). The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% (95% confidence interval, 0.5%–0.9%) in 138,792 individuals. The prevalence values for celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was higher in female vs male individuals (0.6% vs 0.4%; P < .001). The prevalence of celiac disease was significantly greater in children than adults (0.9% vs 0.5%; P < .001).

Conclusions

In a systematic review and meta-analysis, we found celiac disease to be reported worldwide. The prevalence of celiac disease based on serologic test results is 1.4% and based on biopsy results is 0.7%. The prevalence of celiac disease varies with sex, age, and location. There is a need for population-based prevalence studies in many countries.

Section snippets

Methods

We conducted an extensive search on Medline, PubMed, and EMBASE with the following medical subject heading terms and keywords “celiac disease,” “celiac,” “coeliac disease,” “tissue transglutaminase antibody,” “anti-endomysium antibody,” “endomysial antibody,” and “prevalence.” Each one was cross-referenced with “Asia,” “Europe,” “Africa,” “South America,” “North America,” and “Australia.” Because the European Society of Gastroenterology, Hepatology and Nutrition released the first modern

Results

Our search found a total of 3843 articles in the database (Supplementary Figure 1). Of them, 3674 articles were excluded based on the titles or abstracts. Finally, full texts of 169 articles were assessed. Sixty-four additional studies were excluded based on the inclusion and exclusion criteria. Nine more studies were excluded for several reasons detailed in Supplementary Figure 1.4, 5, 22, 23, 24, 25, 26, 27, 28 Ultimately, 96 studies were included in the present meta-analysis (Supplementary

Discussion

The present meta-analysis showed that the pooled global seroprevalence of CD is 1.4% (95% CI, 1.1%–1.7%). The pooled global prevalence of biopsy-confirmed CD is 0.7% (95% CI, 0.5%–0.9%), with the highest prevalence in Europe (0.8%) and Oceania (0.8%), and the least prevalence in South America (0.4%). The present meta-analysis confirms that biopsy-confirmed CD is 1.5 times more common in females than in males, and approximately twice more common in children than in adults.

In our study, the

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: Conflicts of interest These authors disclose the following: Ciaran P. Kelly has acted as a scientific advisor to companies attempting to develop new management approaches for celiac disease including Celimmune, Cour Pharma, Immunogen X, and Takeda Pharmaceuticals, and also acts as the Principal Investigator on a research grant on celiac disease supported by Aptalis; Daniel Leffler is the medical director at Takeda Pharmaceuticals and has received research support/consultancy fees from Alba Therapeutics, Alvine Pharmaceuticals, INOVA Diagnostics, Genzyme, Coronado Biosciences, the Sidney Frank Foundation, and Pfizer; and Peter H. Green has received personal fees from ImmusanT outside of the submitted work. The remaining authors disclose no conflicts.

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Systematic reviews and meta-analysesGlobal Prevalence of Celiac Disease: Systematic Review and Meta-analysis

Background & Aims

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Am J Gastroenterol

Gastroenterology

J Clin Epidemiol

Lancet

Control Clin Trials

Lancet

Gastroenterol Clin Biol

Dig Liver Dis

Dig Liver Dis

Lancet

An Esp Pediatr

Epilepsy Behav

Dig Liver Dis

Dig Liver Dis

Dig Liver Dis

New clues in celiac disease epidemiology, pathogenesis, clinical manifestations, and treatment

Int Rev Immunol

Diagnostic criteria in coeliac disease

Acta Paediatr Scand

European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease

J Pediatr Gastroenterol Nutr

Coeliac disease detected by screening is not silent–simply unrecognized

QJM

Factors associated with serum antibodies to reticulin, endomysium, and gliadin in an adult population

Gut

Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study

Arch Intern Med

High prevalence of coeliac disease in a population-based study from Western Australia: a case for screening?

Med J Aust

Prevalence of celiac disease in Latin America: a systematic review and meta-regression

PLoS One

Prevalence of celiac disease in the northern part of India: a community based study

J Gastroenterol Hepatol

Celiac disease in Tunisian children: a second screening study using a “new generation” rapid test

Immunol Invest

Celiac disease: prevalence, diagnosis, pathogenesis and treatment

World J Gastroenterol

Prevalence of celiac disease in the Asia-Pacific region

J Gastroenterol Hepatol

Are we not over-estimating the prevalence of coeliac disease in the general population?

Ann Med

Systematic review: worldwide variation in the frequency of coeliac disease and changes over time

Aliment Pharmacol Ther

Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition

Arch Dis Child

Metaprop: a Stata command to perform meta-analysis of binomial data

Arch Public Health

Prevalence of asymptomatic celiac disease in a Syrian population sample

JABMS

Association between serum levels of total IgA and IgA class endomysial and antigliadin antibodies: implications for coeliac disease screening

Eur J Gastroenterol Hepatol

Prevalence of coeliac disease and relations to Helicobacter pylori infection and duodenitis in a Swedish adult population sample: a histomorphological and serological survey

Inflammopharmacology

Screening for coeliac disease in healthy blood donors at two immuno-transfusion centres in north-east Italy

Ital J Gastroenterol Hepatol

Subclinical coeliac disease

Ital J Gastroenterol

Prevalence and demographic characteristics of celiac disease among blood donors in Ribeirão Preto, State of São Paulo, Brazil

Dig Dis Sci

Coeliac disease in The Netherlands

Scand J Gastroenterol

Consumption of wheat foodstuffs not a risk for celiac disease occurrence in Burkina Faso

J Pediatr Gastroenterol Nutr

Prevalence of celiac disease in Tunisia: mass-screening study in schoolchildren

Eur J Gastroenterol Hepatol

Prevalence of celiac disease in Egyptian children disputes the east-west agriculture-dependent spread of the disease

J Pediatr Gastroenterol Nutr

Screening of tissue transglutaminase antibody in healthy blood donors for celiac disease screening in the Turkish population

Dig Dis Sci

The prevalence of unrecognized adult celiac disease in Central Anatolia

J Clin Gastroenterol

Systematic reviews and meta-analyses
Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis