PREVALENZA : ANNI 80
ANNI ‘80
8 CD without GFD diagnosed before 2000
Tissue transglutaminase testing
6403 sera
134 tTg+ ( > 7) 3 tTg - (5.1-6.9), EMA +
6 CD diagnosed between 2000 and 2002
120 antibody + 33tTg > 7, EMA –87 tTG > 7, EMA
123 individuals to be biopsied
81 (66%) aggred on
biopsy
17 (14%) refused
21 (17%) could be not
be traced
4 (3%) had died after serum sampling
40 biopsied so far
Comunità Europea 2000
PREVALENZA 1: 49
Prevalence of coeliac disease among 5055 pregnant women
TGASE Units n EMA+
EMA -
DQ2
DQ8
DQ2/8
DQ2/8-
DIAGNOSIS
RATE
TGASE > 9 UI
48 48 42 4 1 1 48 Coeliac
>7 TGASE< 9 UI
10 3 7 4 1 - 5 6 Coeliacs
>5 TGASE<7 UI
20 0 20 6 1 13 2 Coeliacs
TGASE < 5 4977 Negative
TOTAL 5055 51 27 50 6 2 20 Newcases 56
Known cases 12 Known 12
1:4,6 1:74
TUTTA LA CAMPANIA 2000
Italian areas Immigrant CD patients Total CD patients %( n = 34 ) ( n = 1764 )
NORTHERN 11 615 1.8
CENTER 15 603 2.5
SOUTHERN – INSULAR* 8 546 1.5
____________________________________________________________________
* Insular = Sicily
Celiaci tra bimbi immigrati in Italia
TABLE 1: Geographic distribution in our country of the immigrant CD patients
_______________________________________________________EAST EUROPE : Macedonia ( 1 ), Rumania ( 3 ), Poland ( 2 ),
Russia ( 2 ), Serbia ( 1 ), Albania ( 5 )
NORTH AFRICA : Egypt ( 1 ), Morocco ( 6 ), Tunisia ( 4 ), Saharawi ( 2 )
WEST AFRICA : Cape Verde ( 1 )
EAST AFRICA : Somalia ( 1 )
MIDDLE- EAST : Syria ( 1 )
SOUTHERN : Sri-Lanka ( 1 ), Pakistan ( 3 )ASIA ______________________________________________________
QUEST’ANNO 2006
1:33
1:41
1:60
1:50
Tunisia 1: 45
In the recent
past
One in every 50-100 common people, many
apparently healthy
epilessia
Lesioni smalto dentario
esofagite
cardiomiopatia
pancreatite
diabetecolite
ulcere
amenorrea
Dermatite
Erpetiforme
artrite
anemia
neurite
distrofia
nefrite
diarrea
epatite
gastrite
tiroidite
iridociclite
atassia
• Epilessia e calcificazionicerebrali
• Sclerosi Multipla• Emicrania
capelli
• Alopecia• Riduzione diametro
capelli
• Atassia glutinedipendente
• Ipoacusia
Cataratta• Uveite• Cataratta
• Lesioni smaltodentario
• Stomatite aftosa• Modifiche salivare
• Tiroidite• Carcinoma papillare della
tiroide• Iperparatiroidismo
• GERD
(Paterson-Kelly)
• GERD• Esofagite eosinofila• Sindrome di Plummer-Vinson
(Paterson-Kelly)
� Sintomi
� Sintomi atipici
� Patologie associate
� Complicanze
• Cardiomiopatia• Fibrillazione
atriale
• Sarcoidosi• Emosiderosi
• Vomito• Gastrite
linfocitaria
• Diabete• Insufficienza
Pancreatica
• Epatite• Cirrosi biliare
primitiva• Colangite sclerosante• Ipertransaminasemia
• Osteoporosi• Fratture
• Debolezzamuscolare
• Iper-CK-emia
• Sjögren
� Sintomi
� Sintomi atipici
� Patologie associate
� Complicanze
• Depressione• Ansietà• Disturbi della
sfera affettiva
• Diarrea• Dolori addominali• IBS
• Colite• Tumori Intestinali• Cavitazione
linfonodi mesenter• Amenorrea• Infertilità• Aborti ricorrenti
• Nefrite• Insufficienza
renale cronica
• DermatiteErpetiforme
• Psoriasi• Keratosis Pilaris• Xerosi cutanea
• Artrite• Artrite• Artrite reumatoide
• Anemia ferrocarenziale• Anemia megaloblastica• Porpora trombocitopenica• Trombocitosi
� Sintomi
� Sintomi atipici
� Patologie associate
� Complicanze
• Iposplenismo• Iposplenismo
• Neuropatie mot• Gangliopatie
sensoriali• RLS (Restless
Leg Syndrome)
www.medicel.unina.it
But know how and diagnostic facilities VERY different
Most patients
cared for
appropriately Few patients cared for well
Care very occasional,
start after 6 years ! What
about the infants ?
Que c’es qu il a en Algerie ?
Le celiaquie en Algerie en 2020
Population 33.769.669 Trouble digestif 51.040
Enfant 0-14 an 8.878.665 Anemia 24.019
CELIAQUE 337.697 Osteoporosis 18.014
ENFANTS Celiaque
88.787 Anomalies du foie 6.005
Arête de Croissance 4.000
COUT DE LA CELIAQUE
€ 123.410.460 Dinar123.420.500.000
Excess de mort 14.118
Consumption of wheat per capita (Kcal/Day)
Rise in the consumption of wheat flour
Pasta consumption in the E.U. (1990 - 2008)
CONSUMPTION OF
PASTA PER CAPITA
Italy 28.0 kg
Tunisia 11.7 kg
Greece 9.6 kg
France 7.3 kg
Turkey 5.6 kg
Spain 4.7 kg
Israel 4.0 kg
Libya 2.0 kg
Egypt 1.2 kg
Production of pasta in
the world
Italy 3.191.505 t
Turkey 566.303 t
Egypt 400.000 t
France 241.121 t
Spain 224.000 t
Greece 151.000 t
Tunisia 110.000 t
Syria 9.005 t
NorthFranceSpainItaly
North-EastSloveniaBosniaCroatiaAlbania
EastLebanonIsraelSyria
Middle EastGreeceMaltaTurkeyCyprus
SouthMoroccoAlgeriaEgyptLibiaTunisia
MEDITERRANEAN NETWORK FOR THE MANAGEMENT
OF FOOD INDUCED DISEASES
Prevalence of Celiacs
RegionsEstimated Celiacs
today at 1% Estimated celiac
children today at 1%Projected celiac
children in 10 yearsProjected prevalence of CD in next 10 yrs
North 1.627.090 257.033 251.187 1.662.444
N.East 140.184 23.680 23.176 143.553
M.East 847.870 204.665 221.224 928.135
East 330.138 32.684 113.367 390.329
South 1.611.407 461.245 528.115 1.871.015
MED tot 4.556.689 979.307 1.040.220 4.995.476
Diseases in symptomatic cases
Regions GI Symptoms Anaemia Osteopenia Abnormal LiverShort Stature
Children
North 214.069 100.738 75.554 25.185 10.047
N.East 18.557 8.733 6.550 2.183 927
M.East 123.447 58.093 43.570 14.523 8.849
East 52.903 24.896 18.672 6.224 4.535
South 252.846 118.986 89.240 29.747 21.125
MED tot 657.119 309.232 231.924 77.308 41.609
Excess mortality of undiagnosedceliacs
Regions
Death rate deaths/ 1,000 population
Population Expected Deaths next 10 y
Celiacs Deaths Next 10 y
Excess Death in Celiacs next 10
yr
North 9,8 15.762.925 289.149 128.511
N.East 8,7 1.231.961 22.561 10.027
M.East 7,8 5.585.422 109.337 48.594
East 5,1 1.444.604 30.590 13.596
South 4,6 7.678.427 160.448 71.310
MED tot 7,2 31.703.339 612.086 272.038
Costs of undiagnosed celiac disease
Regions
PurchasingPowerParity
StandardizedCost foradult €
Standardized Cost for children €
Total Cost Adult next 10 y €
Total Cost Children next 10
yr €
TOTAL Cost Symptomatic next 10 yr €
North 32 12.588 3.687 2.528.223.744 186.517.102 2.714.740.846
N.East 18 7.119 2.085 116.258.288 8.708.685 124.966.973
M.East 21 8.184 2397 589.492.976 69.734.479 659.227.455
East 16 6.173 1.808 174.475.361 26.119.797 200.595.158
South 8,0 3.145 921 485.651.606 78.068.568 563.720.174
MED 19 37.209 10.899 3.894.101.974 369.148.631 4.263.250.605
Expected N. of Cases, Health Cost and related Deaths
The epidemic of coeliac disease
0
5
10
15
20
25
1950 1960 1970 1980 1990 2000 2010
Celiac Disease Prevalence in the last 50 years
years
Celiacs/1000
The Past : < 100.000
Clinical
Clear CDPotential CD Gluten
Sensitive
The Present : about 1 Million
Clinical
Clear CD
Potential CD Gluten
Sensitive
The Future > 5 Millions
Potential CD Gluten
Sensitive
Clinical
Clear CD
Let us start : it is up to you !
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