High prevalence of celiac disease in apparently healthy blood donors suggests a high prevalence of undiagnosed celiac disease in the Dutch population

Background: In the last few years the prevalence of celiac disease (CD) see ms to have increased. It is clear that subclinical and silent CD exist in a large subgroup of the celiac population. Methods: The aim of this study wa s to evaluate the prevalence of CD in an apparently healthy population. Blo od samples were obtained from 1000 apparently healthy blood donors at Arnhe m and Nijmegen Blood Donation Centers from January 1997 through April 1998. Sera from 660 blood donors were assayed for total IgA. By means of immunof luorescence, antibodies, including those to endomysium (EMA), were determin ed. Serum immunoglobulin levels (IgA) were assayed by means of nephelometry . All donors who had positive serology for EMA underwent small-intestinal b iopsy. Results: Of the 1000 healthy blood donors 3 had positive EMA. Small- intestinal biopsy of two of these showed subtotal villous atrophy (Marsh II Ib), and the third had intraepithelial lymphocytosis and crypt hyperplasia (Marsh II). The prevalence of gluten sensitivity was 1 of 330. Low IgA (0.6 0-0.23 g/l) in our study group was found in 9 of 660 (1%), but no one showe d an IgA less than or equal to 0.02 g/l. Conclusion: Our study shows that t he prevalence of gluten-sensitivity in apparently healthy blood donors is 3 of 1000, which suggests a high prevalence of CD in the Dutch population, i n contrast to the results of the last published Dutch epidemiologic studies . The recorded prevalence will increase further with greater recognition of subclinical and asymptomatic forms detected by screening tests.