Epidemiology

Although coeliac disease was considered to be a disease that affects people of European origin only, recent epidemiological studies have recognised it as a worldwide problem with clinicians in developing countries recognizing patients with coeliac disease (1)

• increasing trend in all autoimmune diseases and introduction of wheat into the diets has been suggested as the reason for this increase in prevalence (1)
• there may be geographical sparing in regions where diets mainly consists of rice
• however the strongest determinant may still be the prevalence of genes predisposing to coeliac disease (HLADQ2 and DQ8).

In UK, it affects up to 1 in 100 individuals. This number is similar in Caucasian populations globally including USA, South America and Australia (2)

In clinical practice, diagnosed cases of coeliac disease falls far short of the expected prevalence indicating that a large amount of undiagnosed patients remain in the population (possibly by a five or ten-fold multiple of existing). This is known as the 'coeliac iceberg'.

Presentation is most common in childhood with peak incidence between 0-5 years. In adults, peak incidence is 40-50 years in women, and 50-60 years in men.

Ninety-eight percent respond to a gluten-free diet.

Reference:

• (1) Mooney PD, Hadjivassiliou M, Sanders DS. Coeliac disease. BMJ. 2014;348:g1561
• (2) British Society of Gastroenterology (BSG) 2010. The management of adults with coeliac disease