Celiac Disease in the Developing World

The prevalence of celiac disease (CD) in many developing countries is similar to that of developed areas, in both low- and high-risk groups. The disorder is underestimated because of lack of disease awareness. CD is strongly associated with HLA-DQ2 in developing countries. Clinical presentation may be characterized by chronic diarrhea, anemia, stunting and increased mortality. Few studies have addressed atypical or silent CD. Diagnosis is initially made by serologic tests and is confirmed by small intestinal biopsies. In developing countries the adherence to the treatment is still difficult because of poor availability of dedicated gluten-free food.

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The prevalence of celiac disease (CD) in developing countries may be underestimated because of lack of awareness and low suspicion of the disease.
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Physicians must learn to recognize the variable clinical presentations of CD including the classic, atypical, and silent forms. Screening for the disease should be done among at-risk groups for early identification of patients with CD.
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Gluten-free diet represents a challenge for patients and their physicians, especially in these regions of the world, although it remains the only effective and safe therapy available.
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Large prospective studies are needed to assess the incidence, the clinical course, the efficacy of treatment modalities used, patient compliance, disease complications, and response to treatment in developing countries.

Key Points

Introduction

Celiac disease (CD) is an autoimmune disorder that occurs in genetically predisposed individuals on ingestion of gluten. It has a prevalence of 0.8% to 2.67% in the Western world. However, it is still underdiagnosed because of lack of specificity of clinical symptoms, and the diagnosis is often made after considerable delay. First thought to be uncommon in developing countries, recent studies from the Middle East (ME), North Africa (NA), south and east Asia (SEA), and Latin America (LA) suggest it is almost equally prevalent in those regions. The true prevalence of the disease, its genetic background, its clinical features, and response to treatment are still not fully explored in many parts of the developing world. Contributing to the lack of studies are different factors including limited knowledge of the disease and limited funds available for research.

A literature review was performed using the electronic databases PubMed and Medline (1950–2012) as search engines, and celiac disease was used as a MeSH (medical subject headings) term. The search was limited to ME, SEA, Africa, and LA. This article compares the parameters of CD with those in Western countries, its epidemiology in low-risk and high-risk populations, its genetic background, its most common clinical presentations, and the diagnostic tests used and their reported sensitivity and specificity. The efficacy of the treatment modalities used and compliance with a gluten-free diet (GFD) are determined.

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