Prevalence of occult celiac disease in healthy Iranian school age children.

BACKGROUND   Several studies have shown the prevalence of celiac disease (CD) to be around 1% in Iran, which is similar to the worldwide prevalence. There is scant information on occult CD in apparently healthy school age children. This study, as the first such study in Iran, aims to determine the prevalence of occult CD in healthy Iranian school age children. METHODS In this cross-sectional study, we screened healthy school age children for CD by serum IgA and IgA anti-tissue transglutaminase antibody (tTG) levels. Measurement of these antibodies was by enzyme linked immunosorbent assay. A recheck of positive tTG tests was performed and patients who tested positive underwent endoscopic duodenal biopsies. The biopsy samples were scored according to the Marsh classification by an experienced pathologist. RESULTS A total of 634 children (314 males, 320 females; mean age: 12.8 years) were included in the study. All children and/or their parents completed a questionnaire and children underwent an initial physical examination to determine study eligibility. Positive serum tTG was noted in 3 (0.5%; 2 females) out of 634 patients. Duodenal biopsies were consistent with CD in these 3 subjects. The mean age of patients with CD was 14.3 years (range: 12-17 years). The female to male ratio was 2:1. These cases had no signs and symptoms, but a gluten-free diet was recommended according to pathologic changes in their small bowels and results of the tTG test. CONCLUSION The prevalence of occult CD in these children is 0.5%, which is half of the prevalence of CD in Iranian adults. The anti-tTG concentration at initial serological CD screening is highly informative in determining occult cases of CD. The question is whether all non-symptomatic cases should be treated with a gluten-free diet or not.