Prevalence of celiac disease in Argentina: Screening of an adult population in the La Plata area

OBJECTIVES: Up to now, the epidemiological characteristic of celiac disease among adults in South America remains unknown. The present prospective scr eening was designed to determine the prevalence of celiac disease in adults from the general population in an urban area of Argentina. METHODS: Between January, 1998, and May, 2000, all couples attending a cent ralized laboratory for an obligatory prenuptial examination in the La Plata area were offered participation in a screening program for celiac disease. The study included 2000 subjects (996 women; median age 29 yr, range 16-79 yr). All individuals completed a clinical questionnaire at the time that s erum samples were obtained. A three-step screening protocol was used, as fo llows: 1) all samples were tested for antigliadin antibodies (AGAs) (type I gA and IgG); 2) samples that were IgA AGA positive were tested for antiendo mysial antibody (EmA type IgA); samples that were positive for AGA-G but ne gative for IgA AGAs were tested for total IgA serum levels and EmA type IgG ; and 3) subjects who were EmA-positive were referred for intestinal biopsy . RESULTS: At the end of the screening we detected 10 subjects who were EmA-A positive and two others who were IgA-deficient (both were EmA-G positive). Up to now, 11 of the 12 subjects (including nine EmA-positive and two IgA- deficient subjects) had endoscopic intestinal biopsies showing the characte ristic celiac histology. The remaining EmAC, positive individual was consid ered to be affected by celiac disease. The overall prevalence assessed was 1:167 (6.0 x 1000 subjects; 95% CI = 3.1-10.5). Eight of the 12 (67%) subje cts were female (1:124; 8.0 x 1000; 95% CI = 3.5-15.8) and four (33%) were male (1:251; 4.0 x 1000; 95% CI = 1.1-10.2). Although eight new patients we re considered to be asymptomatic, three presented with a subclinical course and one was classically symptomatic. Only one patient had been previously diagnosed with celiac disease. CONCLUSIONS: Our screening protocol showed a very high 2 prevalence of celi ac disease for an urban area of Argentina that is ethnically similar to 90% of the general population of the country. The prevalence among women was d ouble that for men, and the heterogeneous clinical picture of new patients showed predominance of asymptomatic cases. (Am J Gastroenterol 2001;96:2700 -2704. (C) 2001 by Am. Coll. of Gastroenterology).