Prevalence of celiac disease in Germany: A prospective follow-up study

Table 1 Prevalence of celiac disease in different countries

Country	Prevalence	Characteristics of populations studied			Antibody test method
		n	Age (yr) mean/median (range)	Males	tTGA	AGA	EMA
Population-representative samples
Germany (present study)	1:270	2157	42.6 (18-65)	48.03%	-	-	-
New Zealand[1]	1:82	1064	50.2 (> 18)	39.80%		-	-
Iran[2]	1:104	2799	33.7 (18-66)	50%	-		-
Ireland[3]	1:122	1823	NA (15-65)	NA		-	-
Sweden[4]	1:190	1894	50 (25-74)	50%		-	-
Netherlands[5]	1:286	1440	40.6 (20-59)	46%	-		-
Spain[6]	1:390	1170	44.9 (2-89)	44.70%		-	-
Italy[7]	1:559	2237	44 (20-87)	46.90%			-
Greece[8]	1:558	2230	46 (18-80)	45%	-		-
Finland[9]	1:47	2815	NA (52-74)	48%	-
Finland[10]	1:42	4846	NA (30-64)	47%	-		-
Italy[10]	1:145	2759	NA (30-64)	42%	-		-
Germany[10]	1:344	3098	NA (30-64)	49%	-		-
Blood donors
Mexico[11]	1:37	1009	34 (NA)	68%	-
Italy[12]	1:100	1002	33 (13-90)	43.40%	-		-
United States[13]	1:105	2845	NA	43%	-	-	-
Iceland[14]	1:136	813	36 (17-64)	76.30%	-
Brazil[15]	1:214	2045	32.8 (18-61)	87.60%		-	-
Netherlands[16]	1:333	1000	NA	NA			-
Norway[17]	1:340	2069	3 (18-67)	66.30%		-	-
Iran[18]	1:400	2000	35.5 (18-65)	79%		-	-
Brazil[19]	1:681	2045	32.8 (18-61)	87.60%		-	-
Non-population representative collectives
Turkey[20]	1:100	906	38.6 (20-59)	50%	-
Switzerland[21]	1:132	1450	NA (12-18)	39.90%	-		-
Argentina[22]	1:167	2000	29 (16-79)	50%		-	-
Tunisia[23]	1:709	1418	27.5 (17-57)	73%	-		-
England[24]	1:83	7550	59 (45-76)	41%	-		-

tTGA: Tissue transglutaminase antibody; EMA: Endomysial antibody; AGA: Antigliadin antibody; NA: Not available; -: Positive.

Table 2 Clinical presentation in subjects with seronegative findings but with histories suggestive of celiac disease

Age (yr), sex	Clinical presentation
41 yr, female	Diagnosed in 2000, histology unavailable as report destroyed
	Diarrhea, weight loss of 43 kg prior to diagnosis, adynamia, flatulence, psychiatric symptoms, paresthesias in the fingers
	In last six months, new onset of epilepsy with petit-mal seizures
18 yr, female	Diagnosed in 2000, histology unavailable as report destroyed; control biopsies in 1990 and 2005 both without evidence of several signs typical for celiac disease
62 yr, female	Sicca syndrome, lactose intolerance, diarrhea and weight loss
	Diarrhea, weight loss, fatigue, bone pain, alopecia, osteoporosis, cheilosis. Bronchiectasis known for years
60 yr, female	Diagnosed in 1989, no other data available
40 yr, female	Diagnosed in 1989
	Sporadic constipation, meteorism, no diarrhea
56 yr, male	Weight loss, abdominal pain, depressive phases, muscle cramps, eczema on the legs and perianal, meteorism, diarrhea after drinking wheat beer

Table 3 Change in celiac-specific antibody titers over time

No.	Age (yr), sex	Initial examination			First follow up
		tTG-IgA (U/mL)	AGA (U/mL)	EMA	tTG-IgA (U/mL)	AGA (U/mL)	EMA
Classic celiac disease
2	58, F	5.5	19.4	Weak Pos	Neg	Neg	Neg
4	20, F	> 100	27.6	Pos	Neg	Neg	Neg
5	52, F	44.9	24.7	Pos	Neg	Neg	Neg
17	56, M	Neg	78.1	Pos	Neg	Neg	Neg
18	62, F	Neg	Neg	Neg	7	> 100	Neg
Atypical celiac disease
1	40, M	> 100	69.6	Pos	29.9	38.1	Pos
3	42, F	41.9	56.2	Pos	27	20.1	Pos
Transient celiac disease
16	18, F	Neg	Neg	Neg	Neg	Neg	Neg

No.: Subject number; F: Female; M: Male; tTG-IgA: Tissue transglutaminase immunoglobulin A; AGA: Antigliadin antibody immunoglobulin A; EMA: Endomysial antibody; Pos: Positive; Neg: Negative.

Table 4 Clinical presentation, histology and human leukocyte antigen findings in subjects with celiac disease

No.	Age (yr), sex	Histology	HLA DQ2	Clinical presentation
Classical celiac disease
2	58, F	IIIc	Pos	Diarrhea, abdominal cramps, angular cheilitis, osteoporosis, depression, brittle nails, hypothyroidism
4	20, F	IIIa-IIIc	Pos	Diarrhea, weight variability, circulatory collapse, cheilosis, depression, anxiety, insomnia, brittle nails, restless-leg syndrome
5	52, F	IIIb	Pos	Fatigue, 1 intestinal cramping, nausea, vomiting, weight loss, paresthesias in the hands, joint, bone and abdominal pains, anxiety, depression, Sicca syndrome, muscle cramps
17	56, M	IIIc	Pos	Weight loss, abdominal cramping, depressive phases, muscle cramps, anal eczema, meteorism, diarrhea following consumption of wheat beer
18	62, F	IIIc	Pos	Diarrhea, weight loss, fatigue, bone pain, alopecia, osteoporosis, cheilosis, bronchiectasia
Atypical celiac disease
1	40, M	0, IIIc	Pos	Psoriatic lesion on the head
3	42, F	IIIc	Pos	No symptoms, suspected lactose intolerance
Transient celiac disease
16	18, F	NoHisto, ED 1985	Neg	Diarrhea, weight loss, Sicca syndrome, lactose intolerance since 2004

HLA: Human leukocyte antigen; No.: Subject number; Age: In years; NoHisto: Histological findings unavailable; F: Female; M: Male; Histology: Histological findings classified according to Marsh stage; NA: Not available; Pos: Positive; Neg: Negative.