The smaller size of the 'coeliac iceberg' in adults

Background: Since it has been ascertained that the prevalence of coeliac disease in the general paediatric population is 3.3 per 1000, we decided to evaluate this prevalence in the general adult population. Methods: Two thousand two hundred and thirty-seven adult subjects aged 20-87 years, representative of a population with sociodemographic characteristics typical of Western European countries with regard to sex and age, were studied. In all serum IgA antiendomysial antibodies (EMA) were searched for, and all patients who turned out to be positive underwent intestinal biopsy. Results: Four symptomless subjects aged between 20 and 39 years proved positive at the IgA EMA screening. The intestinal biopsy confirmed coeliac disease in all of them. The prevalence in our study group was, therefore, 1.8 per 1000. Conclusions: This study shows that the size of the submerged part of the 'coeliac iceberg' is perhaps smaller in the adult population and suggests a linear trend towards a lower coeliac disease prevalence as age increases.