Epidemiology

Celiac 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. [1] [2] [3] However, although seroprevalence is about the same, biopsy-confirmed celiac disease is slightly less common in South America, the Middle East, Turkey, and sub-Saharan Africa. [1]  With the exception of Malaysia and Vietnam, population-based studies from the far East, including China, Japan, and Southeast Asia, are lacking. [4] [5]  In North America, after several decades of rising prevalence, the prevalence of celiac disease appears stable in recent years. [6]

Women are slightly more likely to be affected by celiac disease. [1] In clinical practice they make up almost two-thirds of diagnosed patients. The first peak period of presentation is in childhood around age 6 to 7 years, but celiac disease can arise as soon as gluten is introduced. A second, larger peak occurs in the fourth and fifth decades. Although the most common age at diagnosis in the US is about 40 years, celiac disease may be diagnosed at any age. [7] [8]

Silent celiac disease is serologic and histologic evidence of celiac disease, but without any evident symptoms, signs, or deficiency states. The proportion of celiac disease that is truly silent is not well known, but it is thought to account for at least 20% of patients.

Refractory celiac disease is a specific diagnosis within the category of nonresponsive celiac disease, defined as the persistence of clinical symptoms and histologic 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 celiac disease in patients with celiac disease is not well known but is felt to be approximately 1%.

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