PREVALENZA : ANNI 80

ANNI ‘80

8 CD without GFD diagnosed before 2000

Tissue transglutaminase testing

6403 sera

134 tTg+ ( > 7) 3 tTg - (5.1-6.9), EMA +

6 CD diagnosed between 2000 and 2002

120 antibody + 33tTg > 7, EMA –87 tTG > 7, EMA

123 individuals to be biopsied

81 (66%) aggred on

biopsy

17 (14%) refused

21 (17%) could be not

be traced

4 (3%) had died after serum sampling

40 biopsied so far

Comunità Europea 2000

PREVALENZA 1: 49

Prevalence of coeliac disease among 5055 pregnant women

TGASE Units n EMA+

EMA -

DQ2

DQ8

DQ2/8

DQ2/8-

DIAGNOSIS

RATE

TGASE > 9 UI

48 48 42 4 1 1 48 Coeliac

>7 TGASE< 9 UI

10 3 7 4 1 - 5 6 Coeliacs

>5 TGASE<7 UI

20 0 20 6 1 13 2 Coeliacs

TGASE < 5 4977 Negative

TOTAL 5055 51 27 50 6 2 20 Newcases 56

Known cases 12 Known 12

1:4,6 1:74

TUTTA LA CAMPANIA 2000

Italian areas Immigrant CD patients Total CD patients %( n = 34 ) ( n = 1764 )

NORTHERN 11 615 1.8

CENTER 15 603 2.5

SOUTHERN – INSULAR* 8 546 1.5

____________________________________________________________________

* Insular = Sicily

Celiaci tra bimbi immigrati in Italia

TABLE 1: Geographic distribution in our country of the immigrant CD patients

_______________________________________________________EAST EUROPE : Macedonia ( 1 ), Rumania ( 3 ), Poland ( 2 ),

Russia ( 2 ), Serbia ( 1 ), Albania ( 5 )

NORTH AFRICA : Egypt ( 1 ), Morocco ( 6 ), Tunisia ( 4 ), Saharawi ( 2 )

WEST AFRICA : Cape Verde ( 1 )

EAST AFRICA : Somalia ( 1 )

MIDDLE- EAST : Syria ( 1 )

SOUTHERN : Sri-Lanka ( 1 ), Pakistan ( 3 )ASIA ______________________________________________________

QUEST’ANNO 2006

1:33

1:41

1:60

1:50

Tunisia 1: 45

In the recent

past

One in every 50-100 common people, many

apparently healthy

epilessia

Lesioni smalto dentario

esofagite

cardiomiopatia

pancreatite

diabetecolite

ulcere

amenorrea

Dermatite

Erpetiforme

artrite

anemia

neurite

distrofia

nefrite

diarrea

epatite

gastrite

tiroidite

iridociclite

atassia

• Epilessia e calcificazionicerebrali

• Sclerosi Multipla• Emicrania

capelli

• Alopecia• Riduzione diametro

capelli

• Atassia glutinedipendente

• Ipoacusia

Cataratta• Uveite• Cataratta

• Lesioni smaltodentario

• Stomatite aftosa• Modifiche salivare

• Tiroidite• Carcinoma papillare della

tiroide• Iperparatiroidismo

• GERD

(Paterson-Kelly)

• GERD• Esofagite eosinofila• Sindrome di Plummer-Vinson

(Paterson-Kelly)

� Sintomi

� Sintomi atipici

� Patologie associate

� Complicanze

• Cardiomiopatia• Fibrillazione

atriale

• Sarcoidosi• Emosiderosi

• Vomito• Gastrite

linfocitaria

• Diabete• Insufficienza

Pancreatica

• Epatite• Cirrosi biliare

primitiva• Colangite sclerosante• Ipertransaminasemia

• Osteoporosi• Fratture

• Debolezzamuscolare

• Iper-CK-emia

• Sjögren

� Sintomi

� Sintomi atipici

� Patologie associate

� Complicanze

• Depressione• Ansietà• Disturbi della

sfera affettiva

• Diarrea• Dolori addominali• IBS

• Colite• Tumori Intestinali• Cavitazione

linfonodi mesenter• Amenorrea• Infertilità• Aborti ricorrenti

• Nefrite• Insufficienza

renale cronica

• DermatiteErpetiforme

• Psoriasi• Keratosis Pilaris• Xerosi cutanea

• Artrite• Artrite• Artrite reumatoide

• Anemia ferrocarenziale• Anemia megaloblastica• Porpora trombocitopenica• Trombocitosi

� Sintomi

� Sintomi atipici

� Patologie associate

� Complicanze

• Iposplenismo• Iposplenismo

• Neuropatie mot• Gangliopatie

sensoriali• RLS (Restless

Leg Syndrome)

www.medicel.unina.it

But know how and diagnostic facilities VERY different

Most patients

cared for

appropriately Few patients cared for well

Care very occasional,

start after 6 years ! What

about the infants ?

Que c’es qu il a en Algerie ?

Le celiaquie en Algerie en 2020

Population 33.769.669 Trouble digestif 51.040

Enfant 0-14 an 8.878.665 Anemia 24.019

CELIAQUE 337.697 Osteoporosis 18.014

ENFANTS Celiaque

88.787 Anomalies du foie 6.005

Arête de Croissance 4.000

COUT DE LA CELIAQUE

€ 123.410.460 Dinar123.420.500.000

Excess de mort 14.118

Consumption of wheat per capita (Kcal/Day)

Rise in the consumption of wheat flour

Pasta consumption in the E.U. (1990 - 2008)

CONSUMPTION OF

PASTA PER CAPITA

Italy 28.0 kg

Tunisia 11.7 kg

Greece 9.6 kg

France 7.3 kg

Turkey 5.6 kg

Spain 4.7 kg

Israel 4.0 kg

Libya 2.0 kg

Egypt 1.2 kg

Production of pasta in

the world

Italy 3.191.505 t

Turkey 566.303 t

Egypt 400.000 t

France 241.121 t

Spain 224.000 t

Greece 151.000 t

Tunisia 110.000 t

Syria 9.005 t

NorthFranceSpainItaly

North-EastSloveniaBosniaCroatiaAlbania

EastLebanonIsraelSyria

Middle EastGreeceMaltaTurkeyCyprus

SouthMoroccoAlgeriaEgyptLibiaTunisia

MEDITERRANEAN NETWORK FOR THE MANAGEMENT

OF FOOD INDUCED DISEASES

Prevalence of Celiacs

RegionsEstimated Celiacs

today at 1% Estimated celiac

children today at 1%Projected celiac

children in 10 yearsProjected prevalence of CD in next 10 yrs

North 1.627.090 257.033 251.187 1.662.444

N.East 140.184 23.680 23.176 143.553

M.East 847.870 204.665 221.224 928.135

East 330.138 32.684 113.367 390.329

South 1.611.407 461.245 528.115 1.871.015

MED tot 4.556.689 979.307 1.040.220 4.995.476

Diseases in symptomatic cases

Regions GI Symptoms Anaemia Osteopenia Abnormal LiverShort Stature

Children

North 214.069 100.738 75.554 25.185 10.047

N.East 18.557 8.733 6.550 2.183 927

M.East 123.447 58.093 43.570 14.523 8.849

East 52.903 24.896 18.672 6.224 4.535

South 252.846 118.986 89.240 29.747 21.125

MED tot 657.119 309.232 231.924 77.308 41.609

Excess mortality of undiagnosedceliacs

Regions

Death rate deaths/ 1,000 population

Population Expected Deaths next 10 y

Celiacs Deaths Next 10 y

Excess Death in Celiacs next 10

yr

North 9,8 15.762.925 289.149 128.511

N.East 8,7 1.231.961 22.561 10.027

M.East 7,8 5.585.422 109.337 48.594

East 5,1 1.444.604 30.590 13.596

South 4,6 7.678.427 160.448 71.310

MED tot 7,2 31.703.339 612.086 272.038

Costs of undiagnosed celiac disease

Regions

PurchasingPowerParity

StandardizedCost foradult €

Standardized Cost for children €

Total Cost Adult next 10 y €

Total Cost Children next 10

yr €

TOTAL Cost Symptomatic next 10 yr €

North 32 12.588 3.687 2.528.223.744 186.517.102 2.714.740.846

N.East 18 7.119 2.085 116.258.288 8.708.685 124.966.973

M.East 21 8.184 2397 589.492.976 69.734.479 659.227.455

East 16 6.173 1.808 174.475.361 26.119.797 200.595.158

South 8,0 3.145 921 485.651.606 78.068.568 563.720.174

MED 19 37.209 10.899 3.894.101.974 369.148.631 4.263.250.605

Expected N. of Cases, Health Cost and related Deaths

The epidemic of coeliac disease

0

5

10

15

20

25

1950 1960 1970 1980 1990 2000 2010

Celiac Disease Prevalence in the last 50 years

years

Celiacs/1000

The Past : < 100.000

Clinical

Clear CDPotential CD Gluten

Sensitive

The Present : about 1 Million

Clinical

Clear CD

Potential CD Gluten

Sensitive

The Future > 5 Millions

Potential CD Gluten

Sensitive

Clinical

Clear CD

Let us start : it is up to you !