Celiac Disease Screening among Healthy Blood Donors in Hungary

Abstract

Background: Celiac disease (CD) is a common chronic systemic autoimmune disease in Europe. The prevalence of CD in Hungarian children is estimated at 1.2 – 1.4 %. To date, however, no data on adult CD prevalence has been published.

Aims: Analysis of the serological evidence for CD among Hungarian adults in order to estimate its prevalence.

Methods: Plasma samples from 4155 healthy blood donors were anonymously screened for circulating IgA autoantibodies by a highly sensitive tissue transglutaminase ELISA. Positive results were subsequently confirmed by endomysial antibody test.

Results: Endomysial antibody test confirmed positivity in 25 samples suggesting a prevalence of CD of at least 0.6 % (1:166). Since no identification on the samples was provided, no further examinations could be done on endomysial antibody positive individuals.

Conclusions: The first serological screening study among healthy Hungarian adult blood donors showed a prevalence of CD similar to other central European countries and lower than that in Hungarian children. Among countries worldwide, the Hungarian prevalence of CD appears to be in the mid-range, although pediatric data suggest a higher prevalence.

Zusammenfassung

Hintergrund: Die Zöliakie ist eine häufige, chronische systemische Autoimmunerkrankung in Europa. Ihre Prävalenz bei Kindern in der Allgemeinbevölkerung Ungarns liegt bei 1,2 – 1,4 %. Bislang gibt es keine Daten hinsichtlich der Prävalenz bei Erwachsenen in Ungarn.

Ziele: Analyse der Seren von Erwachsenen in Ungarn zur Ermittlung der Prävalenz der Zöliakie.

Methoden: Plasmaproben von 4155 gesund erscheinenden Blutspendern wurden anonymisiert und hinsichtlich zirkulierender IgA-Autoantikörper gegen Gewebstransglutaminase mittels eines hoch sensitiven ELISA untersucht. Die positiven Ergebnisse wurden mithilfe eines Endomysium-Antikörpertests verifiziert.

Ergebnisse: Der Endomysium-Antikörpertest war bei 25 Proben positiv, insofern scheint die Prävalenz der Zöliakie bei mindestens etwa 0,6 % (1:166) zu liegen. Da die Proben anonymisiert getestet wurden, konnten die Betroffenen nicht weiter untersucht werden.

Schlussfolgerungen: Die erste serologische Screeningstudie bei gesund erscheinenden ungarischen Blutspendern lieferte eine Zöliakieprävalenz, die den Prävalenzwerten aus anderen zentraleuropäischen Ländern bei Erwachsenen gleicht, aber geringer ist als bei Kindern in Ungarn. Global gesehen liegt die Prävalenz der Zöliakie in Ungarn im mittleren Bereich, obwohl die pädiatrischen Daten eine höhere Prävalenz aufzeigen.

Schlüsselwörter

Gewebstransglutaminase - Endomysiumantikörper - Prävalenz - Zöliakie - Sprue

Key words

tissue transglutaminase - endomysial antibodies - prevalence - celiac disease - sprue

• References

• 1 Corazza GR, Gasbarrini G. Coeliac disease in adults. Baillières Clin Gastroenterol 1995; 9: 329-350
• 2 Dubé C, Rostom A, Sy R et al. The prevalence of celiac disease in average-risk and at-risk Western European populations: a systematic review. Gastroenterology 2005; 128: S57-S67
• 3 Mustalahti K, Catassi C, Reunanen A et al. The prevalence of celiac disease in Europe: results of a centralized, international mass screening project. Ann Med 2010; 42: 587-595
• 4 Lohi S, Mustalahti K, Kaukinen K et al. Increasing prevalence of celiac disease over time. Aliment Pharmacol Ther 2007; 26: 1217-1225
• 5 Biagi F, Pezzimenti D, Campanella J et al. Endomysial and tissue transglutaminase antibodies in coeliac sera: a comparison not influenced by previous serological testing. Scand J Gastroenterol 2001; 36: 955-958
• 6 Giersiepen K, Lelgemann M, Stuhldreher N et al. Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report. J Pediatr Gastroenterol Nutr 2012; 54: 229-241
• 7 Walker MM, Murray JA, Ronkainen J et al. Detection of celiac disease and lymphocytic enteropathy by parallel serology and histopathology in a population-based study. Gastroenterology 2010; 139: 112-119
• 8 Kolho KL, Färkkilä MA, Savilahti E. Undiagnosed coeliac disease is common in Finnish adults. Scand J Gastroenterol 1998; 33: 1280-1283
• 9 Pittschieler K, Ladinser B. Coeliac disease: screened by a new strategy. Acta Paediatr Suppl 1996; 412: 42-45
• 10 Trevisiol C, Not T, Berti I et al. Screening for coeliac disease in healthy blood donors at two immuno-transfusion centres in north-east Italy. Ital J Gastroenterol Hepatol 1999; 31: 584-586
• 11 Rostami K, Mulder CJ, Werre JM et al. High prevalence of celiac disease in apparently healthy blood donors suggests a high prevalence of undiagnosed celiac disease in the Dutch population. Scand J Gastroenterol 1999; 34: 276-279
• 12 Fasano A, Berti I, Gerarduzzi T et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003; 163: 286-292
• 13 Melo SB, Fernandes MI, Peres LC et al. Prevalence and demographic characteristics of celiac disease among blood donors in Ribeirão Preto, State of São Paulo, Brazil. Dig Dis Sci 2006; 51: 1020-1025
• 14 Korponay-Szabó IR, Kovács JB, Czinner A et al. High prevalence of silent celiac disease in preschool children screened with IgA/IgG antiendomysium antibodies. J Pediatr Gastroenterol Nutr 1999; 28: 26-30
• 15 Korponay-Szabó IR, Szabados K, Pusztai J et al. Population screening for coeliac disease in primary care by district nurses using a rapid antibody test: diagnostic accuracy and feasibility study. BMJ 2007; 335: 1244-1247
• 16 Sárdy M, Odenthal U, Kárpáti S et al. Recombinant human tissue transglutaminase ELISA for the diagnosis of gluten sensitive enteropathy. Clin Chem 1999; 45: 2142-2149
• 17 Sárdy M, Csikós M, Geisen C et al. Tissue transglutaminase ELISA positivity in autoimmune disease independent of gluten-sensitive disease. Clin Chim Acta 2007; 376: 126-135
• 18 Collin P, Mäki M, Keyriläinen O et al. Selective IgA deficiency and coeliac disease. Scand J Gastroenterol 1992; 27: 367-371
• 19 Juhász A, Remenyik E, Kónya J et al. Prevalence and age distribution of human herpesvirus-8 specific antibodies in Hungarian blood donors. J Med Virol 2001; 64: 526-530
• 20 Chow MA, Lebwohl B, Reilly NR et al. Immunoglobulin A deficiency in celiac disease. J Clin Gastroenterol 2012; 46: 850-854
• 21 Bahari A, Karimi M, Sanei-Moghaddam I et al. Prevalence of celiac disease among blood donors in Sistan and Balouchestan Province, Southeastern Iran. Arch Iran Med 2010; 13: 301-305
• 22 García Novo MD, Garfia C, Acuña Quirós MD et al. Prevalencia de la enfermedad celiaca en donantes de sangre de la Comunidad de Madrid. Rev Esp Enferm Dig 2007; 99: 337-342
• 23 Henker J, Lösel A, Conrad K et al. Prävalenz der asymptomatischen Zöliakie bei Kindern und Erwachsenen in der Region Dresden. Dtsch Med Wochenschr 2002; 127: 1511-1515
• 24 Hovdenak N, Hovlid E, Aksnes L et al. High prevalence of asymptomatic coeliac disease in Norway: a study of blood donors. Eur J Gastroenterol Hepatol 1999; 11: 185-187
• 25 Ivarsson A, Persson LA, Juto P et al. High prevalence of undiagnosed coeliac disease in adults: a Swedish population-based study. J Intern Med 1999; 245: 63-68
• 26 Johannsson GF, Kristjansson G, Cariglia N et al. The prevalence of celiac disease in blood donors in Iceland. Dig Dis Sci 2009; 54: 348-350
• 27 Johnston SD, Watson RG, McMillan SA et al. Prevalence of coeliac disease in Northern Ireland. Lancet 1997; 350: 1370
• 28 Kochhar R, Sachdev S, Kochhar R et al. Prevalence of coeliac disease in healthy blood donors: a study from north India. Dig Liver Dis 2012; 44: 530-532
• 29 Not T, Horvath K, Hill ID et al. Celiac disease risk in the USA: high prevalence of antiendomysium antibodies in healthy blood donors. Scand J Gastroenterol 1998; 33: 494-498
• 30 Oliveira RP, Sdepanian VL, Barreto JA et al. High prevalence of celiac disease in Brazilian blood donor volunteers based on screening by IgA antitissue transglutaminase antibody. Eur J Gastroenterol Hepatol 2007; 19: 43-49
• 31 Pratesi R, Gandolfi L, Garcia SG et al. Prevalence of coeliac disease: unexplained age-related variation in the same population. Scand J Gastroenterol 2003; 38: 747-750
• 32 Riestra S, Fernández E, Rodrigo L et al. Prevalence of coeliac disease in the general population of northern Spain. Strategies of serologic screening. Scand J Gastroenterol 2000; 35: 398-402
• 33 Sanders DS, Patel D, Stephenson TJ et al. A primary care cross-sectional study of undiagnosed adult coeliac disease. Eur J Gastroenterol Hepatol 2003; 15: 407-413
• 34 Shahbazkhani B, Malekzadeh R, Sotoudeh M et al. High prevalence of coeliac disease in apparently healthy Iranian blood donors. Eur J Gastroenterol Hepatol 2003; 15: 475-478
• 35 Stroikova M, Augul N, Gureev J et al. Screening of blood donors for tissue transglutaminase antibodies in the Ryazan area (Russia). Dig Liver Dis 2006; 38: 617-619
• 36 Vanciková Z, Chlumecký V, Sokol D et al. The serologic screening for celiac disease in the general population (blood donors) and in some high-risk groups of adults (patients with autoimmune diseases, osteoporosis and infertility) in the Czech Republic. Folia Microbiol (Praha) 2002; 47: 753-758
• 37 Weile I, Grodzinsky E, Skogh T et al. High prevalence rates of adult silent coeliac disease, as seen in Sweden, must be expected in Denmark. APMIS 2001; 109: 745-750
• 38 West J, Logan RF, Hill PG et al. Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut 2003; 52: 960-965