Enfermedad celíaca silente: explorando el iceberg en población escolar

Cilleruelo Pascual, M.aL.; Román Riechmann, E.; Jiménez Jiménez, J.; Rivero Martín, M.aJ.; Barrio Torres, J.; Castaño Pascual, A.; Campelo Moreno, O.; Fernández Rincón, A.

doi:10.1016/S1695-4033(02)77934-4

Article information

Fundamento

Los estudios epidemiológicos realizados sobre poblacióninfantil no seleccionada han demostrado una elevadaprevalencia de enfermedad celíaca silente y una baja relaciónde enfermedad celíaca conocida frente a no diagnosticada.

Objetivos

Realizar un cribado de enfermedad celíaca silente en poblaciónescolar, caracterizar clínicamente a estos pacientesy valorar su prevalencia global (casos silentes más sintomáticos).

Métodos

Se determinaron anticuerpos antiendomisio (EMA), inmunoglobulinaA (IgA) sérica y anticuerpos antigliadinaIgG (AGA IgG), si existía déficit de IgA, a los escolares de10 a 12 años del área IX de Madrid.

Resultados

Se han estudiado 3.378 niños (47,8 % de la muestra).Quince fueron EMA positivos y uno déficit de IgA tuvo AGAIgG positivos. La enfermedad celíaca se confirmó mediantebiopsia intestinal en 12 niños, lo que representa unaprevalencia de enfermedad celíaca silente de 1/281. Sietede los 12 niños mostraban hallazgos clínicos, entre los quelos más frecuentes fueron ferropenia, aftas orales recurrentesy malnutrición leve. Previamente a este estudio dedetección habían sido diagnosticados 7 enfermos celíacosen la misma población, con lo que la prevalencia globalcalculada ascendería a 1/220 y la relación entre enfermedadcelíaca conocida y no diagnosticada sería de 1/3,5.

Conclusiones

Se confirma una elevada prevalencia de enfermedad celíacasilente en nuestro medio. La relación entre enfermedadcelíaca conocida y silente es una de las mayores de labibliografía y podría relacionarse con un importante nivelde alerta frente a esta enfermedad por parte de los pediatrasde nuestra área de salud. Un mejor conocimiento delos síntomas menores de la enfermedad celíaca disminuiráel número de casos de enfermedad celíaca no diagnosticada.

Palabras clave:

Enfermedad celíaca

Anticuerpos antiendomisio

Enfermedadcel íaca silente

Detección poblacional

Background

Epidemiological studies have shown a high prevalence ofsilent celiac disease (CD) among unselected pediatric populationsand a low ratio of diagnosed to undiagnosed CD.

Objectives

To quantify the prevalence of silent CD, to assess theclinical features of subclinical CD and to determine the totalprevalence of CD (silent plus symptomatic cases).

Methods

We determined total serum IgA, IgA antiendomysialantibodies (EMA) and IgG antigliadin antibodies (IgGAGA), if IgA deficiency was found, in schoolchildren aged 10–12 years from health district IX in Madrid.

Results

A total of 3, 378 schoolchildren (47.8 % of the eligiblepopulation) were studied. Fifteen were EMA-positive andone child with IgA deficiency was IgG AGA-positive. CDwas confirmed by intestinal biopsy in 12 children, representinga prevalence of undiagnosed CD of 1/281. Of these12 children, 7 showed clinical features of CD. The mostfrequent symptom was iron-deficiency, followed by recurrentaphthous stomatitis and mild malnutrition. Beforethe start of this study, CD had been diagnosed in seven children from the same population, which would increasethe total prevalence of the disease to 1/220 with an estimatedratio of diagnosed to undiagnosed CD of 1 to 3.5.

Conclusions

We confirm the high prevalence of silent celiac diseaseamong the school-aged population. This ratio is one ofthe highest published and could be due to a high diagnosticsuspicion for CD among pediatricians in our health district.Greater awareness of the minor symptoms of CDwould reduce the number of patients with undiagnosedCD.

Key words:

Celiac disease

Antiendomysial antibodies

Unrecognized celiac disease

Population screening

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