Coeliac disease is a common disorder in the US and in Europe. A relatively uniform prevalence has been found in many countries, with pooled global seroprevalence and biopsy-confirmed prevalence of 1.4% and 0.7%, respectively, according to well-designed studies. However, although seroprevalence is about the same, biopsy-confirmed coeliac disease is slightly less common in South America, the Middle East, Turkey, and sub-Saharan Africa. With the exception of Malaysia and Vietnam, population-based studies from the far East, including China, Japan, and Southeast Asia, are lacking. In North America, after several decades of rising prevalence, the prevalence of coeliac disease appears stable in recent years.
Women are slightly more likely to be affected by coeliac disease. In clinical practice they make up almost two-thirds of diagnosed patients. The incidence of refractory coeliac disease in patients with coeliac disease is not well known but is felt to be approximately 1%. The first peak period of presentation is in infancy soon after the initial exposures to gluten, with a second, larger peak in the fourth and fifth decades. Although the most common age at diagnosis in the US is about 40 years, coeliac disease may be diagnosed at any age.
Silent coeliac disease is a serological and histological evidence of coeliac disease, but without any evident symptoms, signs, or deficiency states. The proportion of coeliac disease that is truly silent is not well known, but it is thought to account for at least 20% of patients.
Refractory coeliac disease is a specific diagnosis within the category of non-responsive coeliac disease, defined as the persistence of clinical symptoms and histological abnormalities after at least 6 months on a strict gluten-free diet and in the absence of other evident causes or of overt lymphoma. The incidence of refractory coeliac disease in patients with coeliac disease is not well known but is felt to be approximately 1%.
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