Celiac disease in Middle Eastern and North African countries: A new burden?

Table 1 Prevalence and incidence of celiac disease in Middle Eastern and North African countries among low risk populations

Country	Population	Method	Confirmation by duodenal biopsy	Result
Central Anatolia, Turkey[5]	906 hospitalized adults	t-TG1	Yes	Prevalence 1%
Turkey[6]	2000 healthy blood donors	t-TG12	Yes (incomplete)	Prevalence by serology 1.3% and by histology 1.17%
Iran[7]	2799 healthy individuals	t-TG1, AEA1	Yes	Prevalence 0.96%
Tunisia[8]	6286 school children	t-TG1, AEA1	Yes (incomplete)	Prevalence 0.64%
Tunisia[9]	1418 healthy blood donors	AEA1	Yes	Prevalence 0.14%
Iran[10]	2000 healthy blood donors	AGA1, AEA1	Yes	Prevalence 0.6%
Israel[11]	1571 healthy blood donors	AEA1, t-TG	Yes (incomplete)	Prevalence 0.63%
Turkey[12]	1263 healthy school children	t-TG1	Yes (incomplete)	Prevalence by serology 0.87% and by histology 0.63%
Egypt[13]	1500 healthy children	t-TG12, AEA1	Yes	Prevalence 0.53%
Jordan[14]	494 000 children	No serology done	Yes	Incidence 1 in 2800 live births, point prevalence 7:100 000
Kuwait[15]	60 000 newborn over 5 years	NR	Yes	1 in 3000 births
Lebanon[16]	42 600 hospitalized children	AGA, AEA	Yes	5 per 1000 hospital admissions
Tunisia[17]	2500 healthy blood donors	AGA12, AEA1	No	Prevalence 0.3%

¹IgA;

²IgG. AEA: Anti-endomysial antibodies; AGA: Anti-gliadin antibodies; tTG: Tissue transglutaminase; NR: Not reported.

Table 2 Prevalence of celiac disease in Middle Eastern and North African countries among high risk populations

Country	Population	Method	Confirmation by duodenal biopsy	Prevalence (%)
Egypt[13]	150 children with diarrhea and failure to thrive	t-TG12, AEA1	Yes	4.7
	250 children with IDDM	t-TG12, AEA1	No	6.4
Saudi Arabia[18]	123 pts with IDDM	AGA1, ARA1	Yes (incomplete)	4.9-8.1
Tunisia[19]	161 pts with Grave disease	AEA1, t-TG1	Yes (incomplete)	3.7
Turkey[20]	136 pts with autoimmune thyroiditis	t-TG1	Yes (incomplete)	5.9
Algeria[21]	116 children with IDDM	AGA12, AEA1	Yes	16.4-20
Iran[22]	100 pts with chronic diarrhea	AGA1, AEA1	Yes	19
Iran[23]	825 children with chronic diarrhea	AGA1, AEA1	Yes	6.5
Iran[24]	250 pts with IDDM	Total IgA, AEA1	Yes	2.4
North-Eastern Libya[25]	243 pts with high clinical suspicion	NR	Yes	31.7
Eastern Saudi Arabia[26]	145 pts with high clinical suspicion	AEA1, ARA1	Yes	4-11
Egypt[27]	25 pts with refractory iron deficiency anemia	AGA2, AEA1, t-TG2, ARA	Yes	44
Turkey[28]	100 pts with IDDM	AEA1	Yes	6
Iraq[29]	40 pts with IDDM	NR	Yes	15
Libya[30]	234 pts with IDDM	AGA, t-TG, ARA, AEA	Yes	10.3
Tunisia[31]	348 pts with IDDM	AEA1, t-TG	Yes	2.6-4
Turkey[32]	122 pts with IDDM	Total IgA, AEA1	Yes	2.45

¹IgA;

²IgG. IDDM: Insulin dependent diabetes mellitus.

Table 3 Clinical presentation of celiac disease in the Middle East and North Africa

Country	Population	Abdominal distention/flatulence (%)	Diarrhea (%)	Short stature (%)	Weight loss/failure to grow (%)	Abdominal pain (%)
Iran[7]	29 adults with CD detected by screening	55.5	22.2	NR	NR	18.5
Jordan[14]	34 pts with CD	44.0	65.0	53.0	NR	44.0
Kuwait[15]	20 children with CD	80.0	100.0	25.0 (rickets)	100.0	NR
Lebanon[16]	65 children with CD	26.2	60.0	NR	49.2	NR
Turkey[33]	60 Adults with CD	48.3	66.7	NR	50.0	NR
Iran[39]	52 pts with CD	32.7	48.1	23.1	78.8	NR
Iraq[45]	10 children with CD	100.0	100.0	NR	100.0	NR
Turkey[46]	104 children with CD	60.6	81.7	45.2	44.0-50.0	23.0
Turkey[47]	45 children with CD	NR	40.0	51.0	NR	NR
Libya[25]	77 children with suspected CD	49.0	53.0	23.0	100.0	15.0
Saudi Arabia[26]	10 children with suspected CD	NR	50.0	10.0	30.0	30.0
Egypt[27]	11 pts with anemia and CD	18.2	45.5	45.5	57.1	63.6
Saudi Arabia[48]	16 adults with CD	NR	37.0	18.5	NR	18.5
Libya[49]	39 pts with with CD	61.5	59.0	7.7	82.0	20.5

CD: Celiac disease.

Table 4 Serological diagnosis of celiac disease in Middle Eastern and North African countries

Country	Population	AGA (%)		AEA (%)		t-TG Ab (%)
		Sensitivity	Specificity	Sensitivity	Specificity	Sensitivity	Specificity
Turkey[6]	2000 healthy individuals	NR	NR	NR	NR	90.0	NR
Iran[7]	2799 healthy individuals	NR	NR	19.0	100.0	100.0	99.0
Israel[11]	1571 healthy blood donors	NR	NR	20.0	100.0	50.0-60.0	25.0-38.0
Tunisia[17]	2500 healthy blood donors	100.0	84.0	NR	NR	NR	NR
Algeria[39]1	116 children with IDDM	IgA AGA, IgG AGA, and IgA AEA
		Sensitivity		Specificity
		80.0		100.0
Turkey[46]	104 children with CD	76.0 (IgA), 94.0 (IgG)	NR	90.0	NR	NR	NR
Saudi Arabia[26]	145 high risk patients	NR	NR	NR	100.0	NR	NR
Egypt[27]	11 children with CD	100.0	21.4	81.8	21.4	72.7	85.7
Israel[68]	39 children with CD and 22 healthy children	NR	NR	100.0	100.0	NR	NR

¹Sensitivity and specificity of all tests simultaneously.