High prevalence of undiagnosed coeliac disease in 5280 Italian students screened by antigliadin antibodies

Abstract

Many cases of coeliac disease are currently undiagnosed. We carried out a pilot study on screening for coeliac disease in a school population. The screening protocol consisted of three parts: (1) IgG and IgA antigliadin antibody (AGA) assay; (2) antiendomysium antibody and total serum IgA determinations; (3) jejunal biopsy. A total of 5280 students aged 11-15 years (71.7% of the eligible population) underwent the first evaluation; 113 subjects performed the second tests and 35 of these needed the third investigation. Coeliac disease was diagnosed in 23 cases, most of which were atypical or silent forms. The prevalence of undiagnosed coeliac disease was 4.36 per 1000 screened subjects (95% CI 2.58-6.14) and 5.03 per 1000 (95% CI 3.41-6.65) in the general population. The ratio of known to undiagnosed cases was 1 to 6.4. This high prevalence of undiagnosed coeliac disease raises a number of problems that require further evaluation.