Adult coeliac disease: Prevalence and clinical significance

Background and Aims: Although coeliac disease is a common condition, the ro le of population screening is not clear. The aim of this study was to deter mine the prevalence and clinical significance of coeliac disease in the adu lt population of Christchurch, New Zealand. Methods: A total of 1064 adults randomly selected from the 1996 Christchurc h electoral rolls were enlisted. The subjects were screened for coeliac dis ease using the anti-endomysial antibody test (EMA), and all those with posi tive tests were reviewed and underwent a small bowel biopsy. Results: Twelve of the 1064 persons tested (1.1%) were EMA positive and all had small bowel biopsy histology consistent with coeliac disease. Two of t he 12 subjects were previously known to be EMA positive although neither ha d a small bowel biopsy. One additional subject with known and treated coeli ac disease was also enrolled but was EMA negative. Thus, the overall preval ence of coeliac disease was 13 of 1064 subjects (1.2%, or 1 : 82), 10 of wh om were newly diagnosed (0.9%, or 1 : 106) and three were previously known or suspected to have coeliac disease (0.3%, or 1 : 355). The prevalence in both sexes was similar. Nine of the 12 EMA-positive coeliac disease subject s identified by the use of screening reported symptoms, of which tiredness and lethargy were the most common. The subjects were of normal stature, alt hough females tended to be lean. None of the subjects were anaemic, but fou r were iron deficient and four folate deficient. Five of the 12 had sustain ed bone fractures. Bone mineral density was reduced in males but not in fem ales. Conclusions: The prevalence of coeliac disease in the adult population of C hristchurch, New Zealand, is 1.2%. Unrecognized coeliac disease which was d etected by population screening was three-fold more common than proven or s uspected coeliac disease. Population screening may identify subjects who co uld benefit from treatment. (C) 2000 Blackwell Science Asia Pty Ltd.