Table 1.
The prevalence of celiac disease among high-risk groups.
| S. no. | Authors (year) | Country | Aims | Study design/population | Diagnostic criteria | Results | NOS score |
|---|---|---|---|---|---|---|---|
| 1. | Boudraa et al. (1996) [16] | West Algeria | To assess the prevalence of celiac disease in insulin-dependent diabetes mellitus (IDDM) and explore its presence in their first-degree relatives | Prospective study from 1 January 1993 to 31 December 1994 116 IDDM patients 381 first-degree relatives of IDDM patients |
Serological markers, IgA and IgG antigliadin antibodies (AGA), and IgA antiendomysium antibodies (EMA) Jejunal biopsy of symptomatic patients |
Prevalence of CD in IDDM patients was 16% to 20% (since not all patients with positive serological markers experienced jejunal biopsy, the prevalence can be considerably higher up to 20%) In 1st-degree relatives, 6.8% positive for one serological marker, while 3.4% had villous atrophy. |
6 |
| 2. | Al Attas (2002) [17] | Eastern Saudi Arabia | To estimate CD prevalence in clinically suspicious celiac disease patients and in patients with disorders considered to have an association with CD, such as autoimmune diseases | Hospital-based study Group 1 =145 patients (clinically suspected) Group 2 = 80 with autoimmune diseases Group 3 = 20 patients with IBD Group 4 = 100 heathy blood donors |
IgA-EMA and intestinal biopsy of confirmed cases |
Group 1 = EMA‐positive 7.6%, biopsy confirmed = 4% group 2 = EMA‐positive 2.5% (all have autoimmune thyroid disease (AITD)), and groups 3 and 4 = no positive EMA. |
7 |
| 3. | Ashabani et al. (2003) [18] | Libya | To investigate the CD-related marker occurrence in Libyan children patients with DM | Cohort study conducted on 234 Libyan children with DM (age range 2 to 25 years) and 50 healthy children | IgA and IgG, AGA, anti-tTG, anticalreticulin antibodies, and EMA | 50 (21.3%) positive for IgA and/or IgG-AGA, tTG, and anticalreticulin antibodies 19 of these were EMA positive 24 had biopsy-proven CD including EMA-negative patient with IgA deficiency Overall, CD prevalence found 10.3% |
6 |
| 4. | Al-Ashwal et al. (2003) [19] | Saudi Arabia | To examine celiac disease prevalence in young Saudi patients suffering from type I diabetes mellitus at “King Faisal Specialist Hospital and Research Centre, Riyadh” | Hospital-based research; 123 type 1 diabetic patients | Serum gliadin immunoglobulin (Ig) A and reticulin IgA antibody | Serology positive 10 (8.1%) 6 had jejunal biopsy and showed villus atrophy; thus, prevalence was 4.9%, based on biopsy results and antibodies. |
7 |
| 5. | Nowier et al. (2009) [20] | Egypt | Celiac disease prevalence among Egyptians with type 1 diabetes and the association with autoimmune thyroid disease | Case-control study design where case and control groups were compared 73 type 1 DM patients |
Enzyme-linked immunosorbent assay (ELISA) antibodies to tTG | Prevalence of CD among type 1 DM patients was 5.48% positive anti-tTG antibodies Anti-tTG antibody testing was negative for patients with autoimmune thyroid disease. |
8 |
| 6. | Al-Hussaini et al. (2012) [21] | Middle East | To identify the epidemiology of celiac diseases among type 1 diabetes in Middle Eastern children | Cross-sectional study; 106 children with type 1 diabetes | IgA anti-tTG and EMA | 19 (18%) children showed positive results of anti-tTG and/or EMA 12 (11.3%) children were found to be CD positive by biopsy. |
6 |
| 7. | Saadah et al. (2012) [22] | Saudi Arabia | CD prevalence in adolescent and children patients with type 1 DM | Retrospective hospital record-based study 430 diabetic children |
Anti-tTG antibodies | 91 (21.2%) positive for anti-tTG antibody 48 (11.2%) patients' biopsy confirmed CD (42 asymptomatic). |
3 |
| 8. | Al-Sinani et al. (2013) [23] | Oman | Celiac disease prevalence in Omani children (type 1 diabetics) | A prospective cross-sectional study 103 children with type 1 diabetes |
Anti-tTG IgA, EMA IgA, and total IgA Endoscopy and biopsy |
17% (N = 14) positive anti-tTG 5.5% (n = 5) biopsy proven CD. Among these all 5 were also positive for EMA. |
5 |
| 9. | Farahid et al. (2014) [11] | Jordan | To estimate celiac disease prevalence in AIH patients in Jordan and to determine patients at higher disease risk | Cross-sectional record-based review; 914 AIH patients (108 males and 806 females) aged 20–82 years | EMA IgA and IgG Duodenal biopsy |
117 (12.8%) seropositive for CD. 39 (44.8%) out of 87 biopsy proven CD prevalence among patients with AIH was estimated to be 5.7% in comparison to seroprevalence of 12.8% Higher association was found between CD and age > 40 years, vitamin B12 deficiency, anemia, and other autoimmune diseases for example, Addison disease, diabetes mellitus, and vitiligo. |
6 |
| 10. | Al-Hakami (2016) [24] | Saudi Arabia | To determine the seroprevalence of coexisting autoantibodies among patients with type 1 diabetes and to look for possible association with glycemic control, diabetes duration, and diagnosis at Aseer Central Hospital, Abha | Cross-sectional study 202 T1DM patients were included in this study |
Anti-tTG, EMA | 21 (10.4%) positive for both anti-tTG and EMA No significant association between the age at T1DM glycemic control, duration, and diagnosis and the autoantibody presence was observed. |
5 |
| 11. | Al-Ajlan (2016) [25] | Saudi Arabia | To examine the implications and prevalence of celiac disease among Saudi adults and comparing it with diagnosed with irritable bowel syndrome at Al-Iman General Hospital and Prince Salman Hospital, Riyadh | Prospective case-control study Subjects aged 20-60 980 adult patients Among them, 482 subjects were controls and 498 with IBS |
Anti-tTG and EMA and biopsy | 1.9% CD in control group 9.6% in IBS group 55 out of 980 patients were found to be positive for celiac disease. |
8 |
| 12. | Al-Hakami (2016) [26] | Saudi Arabia | To estimate the prevalence of CD in high-risk groups in Aseer (southwest region) and to determine its associations | Laboratory records (retrospective case-finding) 315 patients |
Anti-tTG and EMA and biopsy | 58 (18.4%) got a positive test for at least one antibody marker 17.5% positive for anti-tTG 15.6% positive for EMA 22 out of 40 biopsies were confirmed for CD Type 1 DM was the most common clinical illness related to these markers with the percentage 47% However, gastrointestinal presentations were observed to be only 11.5%. |
4 |
| 13. | Mansour and Najeeb (2011) [27] | Iraq | To evaluate silent CD frequency in Iraqi patients' sample with type 1 diabetes mellitus | Prospective cross-sectional from November 2008 to December 2009; 62 patients with type 1 diabetes mellitus from age 8 to 42 | IgA, anti-tTG-IgA, anti-tTG-IgG, EMA-IgG, and duodenal biopsy | 11.2% in Iraqi patients with type 1 DM. 43.55% had Marsh 0 16.1% had Marsh I 0% had Marsh II 3.2% had Marsh IIIA 4.83% Marsh IIIB 3.2% Marsh IIIC For diagnostic purposes, EMA and tTG tests were found to be useful. |
6 |
| 14. | Fraser et al. (2003) [28] | Oman | To study the association between occult celiac disease and iron deficiency anemia in Omani adults in Sultan Qaboos University Hospital, Muscat | Hospital-based study 51 patients |
IgA, anti-tTG-IgA, anti-tTG-IgG, EMA-IgG, and duodenal biopsy | Mean Hb 9 with confirmed low ferritin. 2 patients positive IgA-tTG and IgA EMA and IgG tTG One patient biopsy done and showed villous atrophy. Prevalence considered being approximately 1 : 30 in iron deficiency patients and 1 in 200-300 affected in the general population. |
4 |
| 15. | Oujamaa et al. (2019) [29] | Morocco | To examine the prevalence of specific autoantibodies to CD in adult and pediatric population with type 1 diabetes | Multicenter, cross-sectional study Study population consists of 276 adults and pediatric diabetic patients |
Anti-tTG-IgA, anti-tTG-IgG, EMA, HLA-DQ2/DQ8 typing, and duodenal biopsy | Seroprevalence of CD in T1D patients was 9.1% (CI = 95%) 2 cases had biopsy-proven CD. |
5 |
| 16 | Alyafei et al. (2018) [30] | Qatar | To determine the prevalence of autoantibodies in diabetic patients in Qatar | Retrospective cross-sectional study, 490 pediatric patients aged 0.5-16 years | Anti-tTG IgA and anti-tTG IgG Biopsy |
In 365 T1DM, 18 (5%) patients have positive anti-tTG IgA and 16 (4.3%) anti-tTG IgG antibodies. In 46 T2DM, anti-tTG IgA antibodies were found in 4 patients (8.7%), whereas no anti-tTG IgG antibodies detected in any patient. Mucosal biopsy proved celiac disease in 9 out of 12 patients (75%) with positive ATT IgA and IgG antibodies. |
4 |
| 17 | Odeh et al. (2019) [31] | Jordan | To determine the prevalence of biopsy-proven CD among T1DM pediatric patients | Mixed prospective and retrospective study 538 children with T1DM Data collected from 2012 to 2017 |
IgA-tTG and IgG-tTG antibodies Duodenal biopsy | Prevalence of serology positive CD was 16.6% while biopsy-proven CD was 9.1%. | 5 |
| 18 | AlRuwaily et al. (2017) [32] | Saudi Arabia | To determine the prevalence of CD in Down syndrome Saudi patients | Retrospective study, files of 91 pediatric patients for serological markers and biopsy results | Antigliadin antibody (AGA) IgA and IgG, EMA, IgA-tTG, and IgG-tTG antibodies | (i) AGA-IgA found in 32.14% (ii) AGA IgG in 52.38% (iii) EMA tested positive in 14.28% and negative in 69.04% (iv) Anti-tTG IgA was high in 15.5% (v) Serum IgA normal level found in 43% patients while low in 1.2%. Biopsy-confirmed cases of CD was 10.7%. |
5 |
| 19 | Alghamdi et al. (2018) [33] | Saudi Arabia | To determine the prevalence of CD in T1DM patient living in Al-Baha region, Saudi Arabia | Retrospective record-based study 268 T1DM patients of age 2-23 years |
IgA-tTG and IgG-tTG antibodies | Prevalence of serology positive cases of CD was 7.1%.. | 3 |
| 20 | Alshareef et al. (2016) [34] | Saudi Arabia | To determine the prevalence of CD in T1DM patient of Saudi Arabia | Cross-sectional study 218 T1DM patients with age ≥ 12 years |
Anti-tTG antibodies and duodenal biopsy | Raised anti-TTG levels found in 7.3% patients. Duodenal biopsies were done in 12 patients which showed (i) total villous atrophy 3.7% (ii) subtotal villous atrophy 0.8% Chronic duodenitis 0.8% |
4 |
| 21 | Al-Agha et al. (2015) [35] | Saudi Arabia | To investigate the coexistence of autoimmune diseases in T1DM patients | Cross-sectional study 228 patients with age 1-18 years |
Anti-tTG antibodies and jejunal biopsy | Celiac disease was found in 19.7%. CD was also significantly associated with a high level of HbA1C level (OR = 1.016; 95% CI: 0.884-1.166). |
5 |
| 22 | Abdulrazzaq et al. (2018) [36] | UAE | To investigate the presence of autoimmune diseases in Emirati children with Down's syndrome | Cross-sectional study conducted on 92 Down's syndrome patients | Anti-tTG antibodies | Prevalence of CD in study population was 1.1%. | 3 |
Abbreviation: IgA-tTG: antitissue transglutaminase IgA; IgG-tTG: antitissue transglutaminase IgG; EMA: antiendomysium antibodies; AGA: antigliadin antibodies; NOS: Newcastle-Ottawa Scale.