Prevalence of Gluten-Related Disorders in Asia-Pacific Region: A Systematic Review
Sara Ashtari1, Mohamad Amin Pourhoseingholi1, Kamran Rostami2, Hamid Asadzadeh Aghdaei1, Mohammad Rostami-Nejad3*, Luca Busani4, Mostafa Rezaei Tavirani5, Mohammad Reza Zali1
1) Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2) Departments of Gastroenterology, Mid Central DHB, Palmerston Hospital, Palmerston North, New Zealand
3) Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4) Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
5) Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Background & Aims: The epidemiology of gluten-related disorders (GRDs) is still an open field to be explored. We conducted this systematic review based on the current epidemiology knowledge of GRDs, focusing on the changing prevalence of GRDs reported in the Asia-Pacific region.
Methods: We searched Medline, PubMed, Scopus, Web of Science and Cochrane database with the following MeSH terms and keywords: celiac disease (CD), wheat allergy (WA), non-celiac gluten sensitivity (NCGS), dermatitis herpetiformis (DH) and gluten ataxia (GA) and the prevalence studies published from January 1991 to January 2018. Each article was cross-referenced with “Asia-Pacific region” and countries in this region
such as Australia, New Zealand, India, Pakistan, Turkey, Iran and others.
Results: We included 66 studies, which reported the prevalence of GRDs in the Asia-Pacific region. Prevalence of celiac disease was 0.32%-1.41% in healthy children and 0.05%-1.22% in the adult population, while the prevalence in the high risk population was higher (0.6%-11.8%). Previous studies have shown a very low incidence of dermatitis herpetiformis (DH) (<0.001%) and gluten ataxia (GA) in this area. Few studies on NCGS outbreaks have been found in this area due to the lack of specific diagnostic biomarkers. Wheat allergy (WA), although uncommon in most Asian-Pacific countries, is the most common cause of anaphylaxis in this region.
Conclusion: The results of this systematic review suggest the need to plan further proper epidemiological studies in order to understand the natural history of GRDs and to assess its burden on health systems.
Key words: gluten-related disorders – celiac disease – non-celiac gluten sensitivity – wheat allergy.
Abbreviations: AGA: anti-gliadin antibody; CD: celiac disease; DGP: deamidated gliadin peptides; DH: dermatitis herpetiformis; EMA: anti-endomysial antibodies; GA: gluten ataxia; GRDs: gluten-related disorders; IBS: irritable bowel syndrome; NCGS: non-celiac gluten sensitivity; SEIBDs: sub-epidermal immunobullous disorders; t-TG: tissue transglutaminase; WA: wheat allergy.