Epidemiology? What does that mean?

Epidemiology, according to its dictionary definition, is the branch of medicine that deals with the incidence, distribution, and possible control of diseases and other factors relating to health.

Celiac Disease was previously thought to be extremely rare in the United States. Two epidemiological studies published prior to 2000 estimated that between one and 4,800 and one in 10,000 people in the U.S. were affected by Celiac Disease. Population studies published in recent years, however, suggest a much higher prevalence, particularly in individuals of European ancestry. One of the largest studies in the U.S. involved 13,145 participants (4,508 first-degree relatives of patients with celiac disease, 1,275 second-degree relatives, 3,236 symptomatic patients, and 4,126 not-at-risk subjects) who underwent screening. The prevalence of celiac disease was 1:22 in first-degree relatives, 1:39 in second-degree relatives, 1:56 in symptomatic patients, and 1:133 in not-at-risk subjects.

The likelihood of having celiac disease increases to 10% to 20% in persons who have a first-degree relative with the disease, and up to 75% in monozygotic twins. In addition, patients who have type 1 diabetes mellitus, Down's syndrome, Turner's syndrome, or other disorders are at increased risk for developing celiac disease.

Celiac disease also occurs in people not of European descent, although the prevalence is not as great. People from the Punjab and Gujarat regions of India who lived in England developed celiac disease 2.7 times as often as Europeans on a gluten-rich diet; in addition, a disorder termed summer diarrhea has long plagued people of the tropics, especially during the summer months, when wheat commonly replaces maize in the diet. Furthermore, a very high prevalence rate of 5% has been documented in the Saharawi population of northern Africa.

Works Cited

Nelsen DA. Gluten-sensitive enteropathy (celiac disease): more common than you think. Am Fam Physician. 2002;66:2259-2266.

Presutti RJ, Cangemi JR, Cassidy HD, Hill DA. Celiac disease. Am Fam Physician. 2007;76:1795-1802.

Hill ID. Clinical Manifestations and Diagnosis of Celiac Disease in Children. Waltham, MA: UpToDate; 2008.

Barton SH, Kelly DG, Murray JA. Nutritional deficiencies in celiac disease. Gastroenterol Clin North Am. 2007;36:93-108.

Rossi T, Albini C, Kumar V. Incidence of celiac disease identified by the presence of serum endomysial antibodies in children with chronic diarrhea, short stature, or insulin-dependent diabetes mellitus. J Pediatr. 1993;123:262-264.

Talley NJ, Valdovinos M, Petterson TM, et al. Epidemiology of celiac sprue: a community-based study. Am J Gastroenterol. 1994;89:843-846.

What is Celiac Disease?

So perhaps you or one of your loved ones has been diagnosed with Celiac Disease. Or maybe you just want to learn more about a disease that affects millions of people. Your first question is probably this: "Well, what exactly is Celiac Disease?" I'm here to tell you just that.

Celiac Disease, also called Celiac Sprue or Gluten-Sensitive Enteropathy, is a digestive and autoimmune disorder where the digestion of gluten, a protein found in barley, wheat, and rye, prompts the body's immune system to respond by attacking the small intestine. These attacks lead to damage on the villi. Villi are small hair-like projections that line the small intestine and that promote nutrient absorption. When the villi get damaged, nutrients such as folate, fat, calcium, and iron cannot get absorbed well by the body. Over time, a person then becomes malnourished, no matter what they eat.

Celiac Disease and gluten sensitivity have very similar symptoms, however, Celiac Disease is very different in that those diagnosed can develop severe intestinal damage and have long-term health consequences.

Celiac Disease is estimated to affect one in one hundred people worldwide. Two and one-half million Americans are undiagnosed and are at risk for long-term health complications.
These long-term health complications include:

• Iron Deficiency Anemia
• Growth problems in children
• Infertility and Miscarriage
• Lactose Intolerance
• Pancreatic Insufficiency
• Gall Bladder malfunction
• Early onset Osteoporosis or Osteopenia
• Intestinal Lymphomas and other GI Cancers (Malignancies)
• Central and Peripheral Nervous System disorders
• Vitamin and Mineral deficiencies 
• Neurological manifestations, including Ataxia, Epileptic Seizures, Dementia, Migraines, Neuropathy, Myopathy, and Multifocal Leukoencephalopathy.
• The development of other autoimmune disorders such as Type 1 Diabetes, Multiple Sclerosis, anemia, and dermatitis herpetiformus

Celiac Disease is hereditary, meaning that it runs in families. People who have a first-degree relative with Celiac Disease (Parent, Child, Sibling) have a one in ten risk of developing Celiac Disease. Infants are also prone to develop Celiac Disease if they are exposed to gluten before three months of age. Celiac Disease may occur at any time, even among the elderly, though the person diagnosed has to be genetically predisposed to the disease.

So there you have it. I hope now you're a bit more knowledgeable on exactly what Celiac Disease is. My next post will explore in more detail the epidemiology of the disease. See you then!