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Celiac Disease in the Middle East And North Africa

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Celiac disease has long been considered an illness of people coming from a European background. The 1% or possibly higher rate of the disease in the United States is similar to rates across Europe. People from other areas of the world were thought to be much less likely to have CD.

Reports are now coming in from all over the globe indicating that celiac disease is not confined to people of European ancestry. As increasing numbers of countries find celiac disease in their citizens, that knowledge needs to be made clear here. People of diverse backgrounds can still have CD and this fact needs to be recognized.

One recent article described the new knowledge being acquired in the Middle East and North Africa. In the 1990’s, the numbers of individuals with celiac disease was thought to be very low. As screening blood tests became available, it became clear that there are groups of people at much higher risk for celiac disease. In lower risk populations, there may be from 0.14% to 1.17% of people with celiac disease. In those at high risk, the numbers are indeed higher.

In Turkey, Egypt, Iran, Tunisia, Israel, Jordan, Lebanon and Kuwait, people at no specific risk for celiac disease have been screened with blood tests, and the prevalence of celiac disease varies between 0.14% and 1.3%. Biopsy-proven celiac disease has been found in anywhere from 0.033% to 1.17%

In high risk populations, including those with positive family histories of CD, people with type 1 diabetes and thyroid disease, as well as classic symptoms of celiac disease such as malabsorption, diarrhea and weight loss, the percentage of patients with positive blood tests and confirmed by biopsy can be as high as 44%,

As a comparison, in the United States, patients with type 1 diabetes have a 1% to 12% chance of having positive blood tests for celiac disease, and 1% to 11% chance of biopsy proven CD. Among patients studied in Saudi Arabia, Tunisia, Turkey, Algeria, Iran, North-Eastern Libya, Egypt, and Iraq, rates of celiac disease have been between 2.4% and 20% by blood tests, and 2.4% to 16.4% by biopsy. Researchers speculate that the practice of marriage between related individuals may increase the risk in these populations.

Patients in these countries may have classic symptoms of celiac disease, or they may have atypical or silent CD with problems like osteoporosis (thin bones) and anemia alerting physicians to evaluate them for CD.

For people living in these countries, all the research and improved understanding may mean that they get diagnosed more quickly. In the United States, it needs to be understood that people with backgrounds other than Europe can still have celiac disease. Both doctors and prospective patients need this information.

If you have had symptoms making you suspect that you have celiac disease and your ancestry is North African or Middle Eastern, you should make sure your doctor evaluates you thoroughly. If you have some other ethnic background, your doctor should still check you for celiac disease when indicated, because it is clear that celiac disease is not confined to one group of people.

References:
Barada K, Bitar A, Mokadem MAR, Hashash JG, Green P. Celiac disease in Middle Eastern and North African countries: A new burden? World J Gastroenterol 2010; 16(12): 1449-1457.
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