Celiac Disease Markedly Underdiagnosed in Adults, Say Danish Researchers

Study using celiac disease antibody tests suggests that reliance on classic symptoms alone to diagnose patients may be inadequate

UPPSALA, Sweden--()--Celiac disease (CD), which produces unpleasant symptoms and, if untreated, can lead to major health complications, is markedly under-diagnosed in adults, according to research recently released by the University of Copenhagen. The study, published in the Scandinavian Journal of Gastroenterology, supports previous research showing that symptom-based diagnosis alone may be inadequate. The Danish researchers performed serological testing on adults from the Danish general population and estimated that prevalence of CD in Denmark was actually ten-times higher than previously reported. These adults were effectively living with “silent CD.”

“This is the well-known iceberg metaphor where classic symptoms such as abdominal pain and diarrhea are more likely to be diagnosed, but the majority of CD patients remain undiagnosed below the waterline,” said Prof. Allan Linneberg, one of the study authors. “If this phenomenon holds true elsewhere in the world, this would have major implications on the way CD is diagnosed and treated.”

Studies have shown that patients with CD have an increased risk of other autoimmune diseases and gastrointestinal cancer. And, as the study authors point out in their paper, “An early diagnosis of CD is important, since untreated CD may cause micronutrient deficiencies and complications such as osteoporosis, anemia, growth retardation, infertility, and neurological disorders.”

“Many patients may have silent CD, meaning that symptoms aren’t enough to warrant further testing,” added Dr. Linneberg. “Other reasons for underdiagnosis could be low awareness of CD or the lack of consensus regarding serological testing in primary healthcare.”

Diagnosing CD is difficult because many of its symptoms are similar to other diseases. In fact, newer guidelines regard non-gastrointestinal symptoms such as fatigue, iron deficiency and anemia as possible indicators of the disease. An Italian study concluded that the clinical profile of celiac disease has, in fact, changed over the last 15 years, with an increasing rate of non-classical and subclinical phenotypes further complicating diagnosis.

“With many adults not receiving their CD diagnosis until their fourth decade or later, it’s clear that we have to reconsider the classic symptoms and revisit the guidelines that prescribe how and when we use serological testing,” added Dr. Linneberg.

CD is now regarded as one of the most common of the autoimmune diseases in the West, affecting at least one percent of the population globally – and the number is significantly higher in specific countries. A 2012 study published in the American Journal of Gastroenterology estimated that the prevalence of CD in the U.S. is at least 1 in 141, a rate similar to several European countries, but it suggested that most of those affected were undiagnosed. And under-diagnosis can be costly. A 2008 study, conducted by the Celiac Disease Center, Columbia University College of Physicians and Surgeons, determined that costs per patient in the managed care population in the U.S. analyzed in the study decreased significantly in the years following diagnosis.

For the University of Copenhagen study, serological screening for CD biomarkers took place at Thermo Fisher Scientific’s Allerod, Denmark facility using the EliA™ Celikey Tissue Transglutaminase IgA Antibodies Assay and the EliA Deamidated Gliadin IgA and IgG assays. These serological tests are widely available to clinicians in Europe and the U.S.

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Horwitz, A., Skaaby, T., Kårhus, L.L., Schwarz, P., Jørgensen, T., Rumessen, J.J., Linneberg, A. (2015). Screening for celiac disease in Danish adults, Scandinavian Journal of Gastroenterology, 50(7), 824-31. doi:10.3109/00365521.2015.1010571

Volta, U., Caio, G., Stanghellini, V., De Giorgio, R. (2014). The changing clinical profile of celiac disease: a 15-year experience (1998-2012) in an Italian referral center, BMC Gastroenterology, 14:194, doi: 10.1186/s12876-014-0194-x

Rubio-Tapia, A., Ludvigsson, J., Brantner, T., Murray, J., Everhart, J. (2012). The Prevalence of Celiac Disease in the United States, The American Journal of Gastroenterology, 107, 1538-1544. doi:10.1038/ajg.2012.219.

Green, P.H., Neugut, A., Naiyer, A.J., Edwards, Z.C., Gabinelle, S., Chinburapa, V. (2008). Economic benefits of increased diagnosis of celiac disease in a national managed care population in the United States, Journal of Insurance Medicine, 40(3-4), 218-28.


For Thermo Fisher Scientific
Christine Williamson, +1-617-275-6528

Release Summary

Celiac disease (CD), is markedly under-diagnosed in adults, according to research recently released by the University of Copenhagen.


For Thermo Fisher Scientific
Christine Williamson, +1-617-275-6528