High prevalence of undiagnosed coeliac disease in adults: a Swedish population-based study

Objective. To determine the prevalence of coeliac disease in a population-b ased sample of Swedish adults. Design. Population-based cross-sectional study. Setting. Northern Sweden. Subjects. A total of 1894 adults (76%) out of 2500 invited, randomly select ed from the population register after stratification for age and sex. Main outcome measures. Prevalence of biopsy verified coeliac disease, sympt oms of undiagnosed cases, and results of antiendomysium and antigladin seru m antibody tests. Results. Coeliac disease was confirmed by intestinal biopsy showing enterop athy in 10 individuals (seven women and three men), corresponding to a prev alence of 5.3 per 1000 (95% CI = 2.5-9.7). The majority of cases (eight out of 10) had not been diagnosed prior to the screening, although many had sy mptoms compatible with coeliac disease. All individuals with antiendomysium antibody positivity who were subjected to a small intestinal biopsy had en teropathy. Furthermore, all of them also had elevated levels of antigliadin antibodies type IgA and/or IgG. Conclusions, Coeliac disease is common, albeit mostly undiagnosed, in Swedi sh adults. It is likely that the situation is no better in other countries. This highlights the importance of keeping coeliac disease in mind, and of promptly investigating individuals with unexplained, even mild, symptoms co mpatible with the disease. Serological markers, e.g. antigliadin and antien domysium antibodies, are useful tools within this active case-finding strat egy,although the final diagnosis should be based on an intestinal biopsy de monstrating enteropathy.