LETTER TO EDITOR
Year : 2016 | Volume
: 22 | Issue : 1 | Page : 82-
Celiac disease among symptom-free children-more than what is expected
Majid A Almadi1, Abdulrahman M Aljebreen2,
1 Department of Medicine, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, McGill University, Montreal, Canada
2 Department of Medicine, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
Majid A Almadi
Department of Medicine, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, McGill University, Montreal, Canada
|How to cite this article:|
Almadi MA, Aljebreen AM. Celiac disease among symptom-free children-more than what is expected.Saudi J Gastroenterol 2016;22:82-82
|How to cite this URL:|
Almadi MA, Aljebreen AM. Celiac disease among symptom-free children-more than what is expected. Saudi J Gastroenterol [serial online] 2016 [cited 2021 Jan 21 ];22:82-82
Available from: https://www.saudijgastro.com/text.asp?2016/22/1/82/173767
We read with interest the study by Al Hatlani  on the prevalence of celiac disease among an asymptomatic population of children in the Eastern province of Saudi Arabia. We commend the author on his work and believe that his findings do replicate that of our study. 
We do have a concern on the reported histological prevalence of celiac disease in the sample population. The author reported that 32 of the 1141 serum samples were positive for celiac, which would indicate a seroprevalence of 2.8%. Only 10 of those who were positive underwent an endoscopy with histological findings that confirmed the serological test. The author suggested that the histologically proven prevalence is only 1%, which implies that the author presumed that the 22 patients that refused endoscopy would have had a negative histology. That presumption would only be true if those that had refused the biopsies were different in any way from those that agreed to undergo duodenal biopsies, which the author did not demonstrate in the manuscript. Furthermore, we know that the test performance of the anti-tissue transglutaminase antibodies have a high sensitivity (95%) and specificity (94%)  and most probably if endoscopies had been performed on those who had refused, the serological and histological prevalence would have been similar.
Also, the author suggested that screening for celiac disease should be undertaken. We argue that such a strategy is not so clear and there are arguments that go against that recommendation including the age of initiation of serological screening and whether treating asymptomatic patients changes the natural history of the disease.  So at least we would say that such a statement is open to debate.
In addition we wanted to point out that the study by Aljebreen et al.  was conducted on a population of adolescents that were attending schools in different regions of the kingdom thus the author's statement that his study would be the first of its kind would be inaccurate.
Again we commend the author on his effort and believe that his study has an added value to the region.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
|1||Al Hatlani MM. Prevalence of celiac disease among symptom-free children from the Eastern Province of Saudi Arabia. Saudi J Gastroenterol 2015;21:367-71.|
|2||Aljebreen AM, Almadi MA, Alhammad A, Al Faleh FZ. Seroprevalence of celiac disease among healthy adolescents in Saudi Arabia. World J Gastroenterol 2013;19:2374-8.|
|3||Sulkanen S, Halttunen T, Laurila K, Kolho KL, Korponay-Szabó IR, Sarnesto A, et al. Tissue transglutaminase autoantibody enzyme-linked immunosorbent assay in detecting celiac disease. Gastroenterology 1998;115:1322-8.|
|4||Lionetti E, Gatti S, Pulvirenti A, Catassi C. Celiac disease from a global perspective. Best Pract Res Clin Gastroenterol 2015;29:365-79.|