The prevalence of celiac disease in at-risk groups of children in the United States

Objective: In contrast to its prevalence in Europe, celiac disease (CD) is considered rare in the United States. We aimed to determine the prevalence of CD in children presenting with symptoms or conditions associated with CD. Study design: Individuals aged 6 months to 20 years were screened for IgG and IgA antigliadin (ACA-IgG and AGA-IgA) and antiendomysium (EMA) antibodies. Those with only elevated AGA-IgG were screened for selective IgA deficiency. Patients with elevated EMA, or AGA-IgG elevation and selective IgA deficiency were advised to undergo small intestinal biopsy. Results: ii total of 1200 individuals were studied; 34 were EMA positive 26 (19 EMA positive) consented to biopsy: and 21 had CD, giving a prevalence of I in 57 (21/1200). Including the 15 EMA positive patients who refused a biopsy, the prevalence of CD in this study could be as high as 1 in 33 (36/1200). Conclusions: CD is not rare in the United Stales and may be as common as in Europe. AGA and EMA are useful for identifying patients who should undergo a small intestinal undergo a small intestinal biopsy. (J Pediatr 2000;136:86-90).