Ravikumara M, Nootigattu VK, Sandhu BK. (2007) J Pediatr Gastroenterol Nutr. 45(4): 497-9.
Serological screening of 5470 children age 7.5 years from a cohort of 13,971 children in the Avon Longitudinal Study of Parents and Children (ALSPAC) suggested the prevalence of celiac disease (CD) to be at least 1%. ALSPAC is an anonymous study, and hence seropositive children could not be individually identified or undergo biopsy. Inasmuch as all children within ALSPAC suspected of having CD are referred to just 1 center, we aimed to identify children with biopsy-confirmed CD who were likely to be in this cohort and to estimate the magnitude of discrepancy between serology-positive cases and biopsy-confirmed cases. The results suggest that more than 90% of CD in children goes undiagnosed.
This study followed up on findings from the anonymous screening carried out in children from the ALSPAC Birth Cohot Study (see Bingley et al 2004), showing that 1% of children from a general population sample had blood antibody responses consistent with coeliac disease.
Here, the findings suggest that 90% of those children with positive antibody responses had not been identified by their medical practitioners as potentially gluten-sensitive - presumably because they did not show, or report, the overt digestive symptoms classically associated with coeliac disease. As these authors note, untreated coeliac disease has many potential health hazards, so these findings add to the case for population-based screening at an early age.
In some individuals, autoimmune reactions triggered by gluten-sensitivity appear to be associated with otherwise unexplained neurological or psychiatric symptoms; and some reports indicate that gluten sensitivity is unusually common in schizophrenia or related conditions such as autism. (see 'Coeliac' disease and schizophrenia')
The high prevalence of 'silent coeliac' reported here suggests that investigation of possible gluten sensitivity may be particularly worthwhile in 'at risk' groups such as children or adults with neurodevelopmental or psychiatric disorders.