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The abstract below will be published in the April issue of Gastroenterology.
It was accepted for poster presentation for the Annual meeting of the
American Gastroenterological Association. The poster section will be on May
22nd (12-2:30 PM) in Hall D, at the Moscone Center, San Francisco, CA.
 
 
ENDOMYSIUM ANTIBODIES IN BLOOD DONORS PREDICTS A HIGH PREVALENCE OF CELIAC
DISEASE IN THE USA.  T. Not, K. Horvath, *I.D. Hill, A. Fasano, A. Hammed,
G. Magazz. Division of Pediatric Gastroenterology & Nutrition, University
of Baltimore School of Medicine, *The Bowman Gray School of Medicine,
Winston-Salem, +University of Messina, Italy.
 
Several epidemiological studies in Europe using antigliadin (AGA) and
endomysium antibodies (EmA) for initial screening report the prevalence of
celiac disease (CD) to be about 1:300 of the population. EmA is most
reliable for screening with greater than 99% positive predictive value in
subsequent biopsy proven cases. There are no comparable scientific data for
the USA yet and CD is considered rare in this country. Lack of awareness
could result in significant underdiagnosis of CD in the USA.
 
Aim: To determine the prevalence of positive serological tests for CD in
healthy blood donors in USA.
 
Methods: Sera from 2000 healthy blood donors were screened for IgG and IgA
AGA using ELISA test. All those with elevated AGA levels (IgA >18 units
or IgG >25 units) and those with high normal levels (IgA 10-18 units or IgG
15-25 units) were tested for EmA by indirect immunofluorescence using both
monkey esophagus (ME) and human umbilical cord (HUC).
 
Results: The mean age of blood donors was 39 yrs with 52% being men, 87%
being Caucasian, 11.5% African American and 1.5% Asian. 95 (4.75%) of
subjects had elevated AGA levels (IgG and/or IgA). A total of 44 (2.2%) had
an elevated IgA AGA. Of these, 7 were also positive for EmA. No patient
with only raised levels of IgG AGA was positive for EmA. Of the subjects
with high normal AGA levels, one (IgA 12 units, IgG 1.8 units) was positive
for EmA. Among the total of 8 subjects with elevated EmA levels, seven were
Caucasian and one was African American. There was a 100% correlation
between ME and HUC for positivity (8 samples) and negativity (288 samples).
 
Conclusions: The prevalence of elevated EmA levels in healthy blood donors
in USA is 1:250 (8/2000). This is similar to that reported from countries
in Europe where subsequent small intestinal biopsies have confirmed CD in
all those with EmA positivity. Based on a positive predictive value of >99%
for CD in patients with elevated EmA levels, it is likely that the 8 blood
donors identified in this study have CD. These data suggest that CD is not
rare in the USA and may be greatly underdiagnosed. There is need for a
large scale epidemiological study to determine the precise prevalence of
the disease in the USA.