Celiac disease, the most frequent autoimmune pathology in children, which primarily involves the intestine, has one of the highest prevalence in the world in our country: one case in every 60. This is what emerges from a multi-centre study conducted on 9,000 pupils of elementary schools in Verona, Milan, Rome, Padua, Salerno, Ancona, Bari and Reggio Calabria. A result that sees Italy at the forefront in the study of a condition that is increasing and not only in the pediatric age, underlines the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (Sigenp), which conducted the research presented today to the Ministry of Health.
“Despite the growing interest in this condition in the medical and general field – says Claudio Romano, president of Sigenp and director of the Pediatric Gastroenterology and Sistic Fibrosis Operating Unit of the University of Messina – there are still many cases of undiagnosed celiac disease, for where the search for cases that have escaped a diagnosis represents today a primary objective from a health point of view.The therapy of celiac disease consists of a diet, with the strict exclusion of the gluten contained in some cereals, including wheat, for life. Sigenp has undertaken the world’s largest ever study on this issue.” The first level screening – explains the scientific society in a note – was conducted through a simple lancing device to verify, on a drop of blood, the presence of antibodies that indicate genetic predisposition. The positive children in this first survey were then invited to undergo a blood sample to further verify the diagnosis of celiac disease.
“The work we are presenting today – highlights Carlo Catassi, director of the Pediatric Clinic of the Polytechnic University of Ancona and creator of the project – has been published in the journal ‘Digestive and Liver Disease’, one of the first in the world in the field of gastroenterology , available online and visible to all.This is the largest study ever carried out in Italy on celiac disease, one of the largest in the world, and has highlighted the high prevalence of this condition in our country: in Italy about one child out of 60 “He has celiac disease. It is a permanent pathology, which would require timely diagnosis to avoid late complications, even serious ones, such as osteoporosis, infertility, rare cases of cancer”.
In addition to the great diffusion of this condition in Italy, “the study – adds Catassi – also revealed a serious problem of underdiagnosis. Only 40% of cases obtain a diagnosis of celiac disease on clinical grounds. Doctors pay close attention to the slightest suspicion of celiac disease, but parents often don’t take their children to the pediatrician because they don’t detect particular symptoms”. Familiarity with celiac disease and the presence of other autoimmune diseases, which often occur in the same subject or in the family, should be considered among the first alarm bells – the experts warn. Symptoms of celiac disease can be diarrhea or constipation, abdominal pain, iron deficiency anemia, vomiting, chronic fatigue, just to name a few. The pathology can manifest itself “at any age, even in adults – Catassi points out – but it often arises in children after weaning, that is, when the child begins to introduce gluten into his diet, also feeding on flour, bread, pasta and biscuits. The latency is a few months or years, then the pathology can appear. The age group most affected is that which goes from 2 to 10 years “.
Females are more affected than males, in a ratio of 2 cases to 1, Sigenp points out, recalling that almost all autoimmune diseases are more frequent in females. As regards the geographical distribution, it is now certain that Italy is among the countries where the prevalence is higher, together with Sweden, Finland, but also India and North Africa, the specialists list. In Japan or the Philippines, celiac disease is an absolutely rare condition, due to the characteristics of the oriental diet based on rice. But today the situation is changing: populations that hardly fed on wheat derivatives are now starting to consume sandwiches with hamburgers and pizzas, and for this reason the cases of celiac disease are also increasing in those areas.
Experts agree on the causes of the problem: it can be said that 40% of celiac disease depends on genetic predisposition, another 40% on diet, the remaining 20% on still unknown factors. If a person has the genetic predisposition, but will never consume gluten, he will not develop the disease. In the light of these results, it is therefore necessary to find strategies to keep the phenomenon under control. “The indications that emerged from our study underline the need for a national screening of celiac disease – concludes Catassi – because we have verified that, despite the attention that Italian paediatricians place on the subject, underdiagnosis is still a huge problem”.
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