<<Disclaimer: Verify this information before applying it to your situation.>> 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.