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               Summaries from the Baltimore Conference
               ---------------------------------------
 
The University of Maryland School of Medicine sponsored a conference
on July 14-15, 1995 entitled "Celiac Disease:  The Dark Side of the
Gastrointestinal Planet".  Eight of our group members attended this
excellent conference.  In the last Sprue-nik Press, we included
highlights from one of the talks at the conference; here we share with
you highlights of several more talks from the conference.  These will
be presented here in the same order as they were presented at the
conference.
 
 
...............................................................
:      Epidemiology of the Disease in Europe and in U.S.      :
:      -------------------------------------------------      :
:          (Problems, Pitfalls of Published Studies;          :
:       Factors Affecting the Incidence of the Disease;       :
:         Criteria for Future Epidemiologic Studies)          :
: by Salvatore Auricchio, MD     summarized by Mary Guerriero :
:.............................................................:
 
Dr. Auricchio is Professor and Chairman of Pediatrics at the
University Frederico II in Naples, Italy.
 
A great deal of Dr. Auricchio's talk stressed the need for research
into celiac disease (CD).  In Europe, the surveys have shown a high
incidence of CD-one in every 200-300 people.  In the absence of
population studies, how can we ascertain how many people in the U.S.
are celiacs?
 
In the past, people were diagnosed if they were symptomatic and had
severe intestinal lesions.  Now the focus should be to take measures
to ensure earlier diagnosis.  This can be obtained by screening high
risk groups, such as family members of diagnosed celiacs; also people
who have insulin dependent diabetes and Down's syndrome.  Does
diagnosing CD take away diabetes or Down's syndrome?  No, but it
certainly could vastly improve the quality of life for these patients.
 
By screening large groups, such as all those admitted to a hospital or
all blood donors (using anti-gliadin and anti-endomysial serology
tests) many cases of "silent" CD have been found.  Dr. Auricchio feels
that classic celiac disease is only the tip of the iceberg.  Villus
atrophy may not occur in "latent" celiacs who have other features of
CD.  There are many people that show only one symptom, others don't
show any.
 
In Europe, diagnosis at an early age is declining.  It is believed
this is due to prolonged breast feeding, which delays the introduction
of gluten into the diet.  The majority of cases were determined at
school age or later.
 
A 1994 European study showed that in the previous five years, the
incidence of CD was about one in 300 in Sweden, when active screening
took place.  In Finland, when blood donors were tested, one in 270
were shown to be silent celiacs (non-symptomatic with severe
intestinal lesions).  In Italy, where school children were tested, one
in 250 were found to be celiacs.
 
In the U.S., it is generally believed that CD is rare, even in the
segment of the population that is genetically similar to the Europeans
described previously.  If this is true, Dr. Auricchio would be
extremely surprised.
 
At this point Dr. Auricchio began taking questions from the floor:
 
 
Q:  What is the earliest time of life at which you can begin to
    develop the anti-gliadin and anti-endomysial antibodies, and is it
    necessary to be exposed to gliadin to develop them?
 
A:  The youngest age could be only a few weeks after introducing
    gliadin to the diet.  You do need to eat gliadin to form these
    antibodies; if you are on a GF diet these antibodies will not be
    present.
 
 
Q:  It has been suggested that the degree of intermarriages between
    the various ethnic groups explains the apparently lower incidence
    of CD in the U.S.  Do you think this may be correct?
 
A:  No, not at all.  Studies of the groups in the U.S.  with the same
    genetic background as groups in Europe show a much lower incidence
    of CD.  It is more likely that CD is underdiagnosed in the U.S.
 
 
Q:  What is the incidence of CD in non-Caucasians?
 
A:  There are cases, but the rate of incidence is unknown.  A study
    from North Africa suggests the disease is frequent there, but
    there were no statistics from the study.