Celiac Disease is more common than was known, study suggests
Source: Wall Street Journal

by Joseph Pereira

Celiac disease, a serious autoimmune condition that can be caused by eating wheat, barley and other foods, may be more common than previously thought, according to a study published in today's New England Journal of Medicine.

An accompanying editorial strongly recommends widespread screening in the U.S., at least among people with symptoms of the disease, which can lead to osteoporosis, infertility and cancer.

" The prevalence of the disease and the burden of illness related to this condition, particularly if it is not treated, are so high as to potentially support a policy of screening of the general population," wrote Alessio Fasano, director of the University of Maryland's Center for Celiac Research in Baltimore, in the editorial.

Celiac is a disease in which the body's defense system attacks the small intestine, damaging villi, tiny fingerlike protusions that absorb nutrients from food into the bloodstream. The destructive mechanism is triggered by the ingestion of gluten, a protein commonly found in wheat, rye, barley and other foods. As the villi get destroyecl, people who are gluten-intolerant suffer from various degrees of malnourishment.

More than 40 symptoms could indicate the condition. including diarrhea, weight loss, fatigue, bloating and joint pain. Up until recently the disease was thought to be extremely rare in the U.S., with doctors testing for the disease mainly when patients experienced frequent bouts of diarrhea or suffered from such problems as short stature.

But the disease may be more prevalent than thought.

A study of 3,654 students in Finland, ranging in age from 7 to l6, indicates that as many as one in 99, or about 1% of the population, are Celiac sufferers. The disease was discovered in research subjects through intestinal biopsies and testing for antibodies in blood samples.

The Finnish study follou s a U.S. study, published in the Archives of Internal Medicine in February, that showed an incidence rate of one in 133 people, says Dr. Fasano, a principal in the U.S. study. Other studies have indicated a high prevalence in Italy, lreland and other parts of Europe. As the disease is hereditary and many Americans are of European descent, "we can assume that the prevalence in the United States is similar to that in Europe." Dr. Fasano said in an interview.

He said he is undertahno a proJect in which approximately 2,500 symptomatic patients in U.S. and Canada will be tested for Celiac. Already 43 of the 300 people tested over the past two months have shown strong indications they have Celiac disease, he said. "That the highest prevalence for any genetic disease in the U.S.," he said. Other diseases such as diabetes type 1 and cystic fibrosis have much lower incident rates.

The cure is simply to abstain from eating foods containing gluten, which could be found in many prepared foods such as ice cream and desserts served in restaurants. Legislation that would require gluten warnings in food labeling is being discussed in Congress.

"Here's a disease for which there are good tools for diagnosis, an effective remedy and the potential of relieving a large population of people from a lot of misery and discomfort," Dr. Fasano said, "and yet the clisease is being grossly undiagnosed.''

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