HIGH PREVALENCE OF COELIAC DISEASE IN YOUNG HEALTHCARE PROFESSIONALS

S El-Hadi, K Hassan, E Lewis°, A Adisesh°, M Moody*, R Fyfield, G Thomas, PE Williams*, D Tuthill, HR Jenkins

Departments of Child Health, Occupational Health°, Immunology* and Gastroenterology, University Hospital of Wales, Cardiff, UK

INTRODUCTION: Previous reports suggested that Coeliac Disease (CD) was declining in the UK. However, recent studies in our region have contradicted this, showing an increase in the rate of diagnosis of CD following the introduction of serological testing and targeted screening of high risk cases. The current prevalence of CD in the population is thought to be 1 in 2- 6000¹ however this may well be an underestimate.
AIM: To prospectively assess the prevalence of CD amongst healthcare students.
METHODS: All new healthcare students (medical and nursing) attending for hepatitis B serological testing were offered screening for CD. After obtaining informed consent serum was assayed for total IgA, anti-tissue transglutaminase (TTG) using Orgentec Diagnostica GmbH kits, and anti-gliadin antibodies (AGA) using Pharmacia diagnostics kits. For those in whom IgA defiency was identified (IgG) AGA were measured. Students with either raised positive AGA or TTG titres had repeat assays performed in addition to AEA using immunofluorescence technique with Human Umlical Cord. Students with two TTG values above 15 units/ml or two AGA levels above were referred to an adult gastroenterologist for assessment, counselling and endoscopy.
RESULTS: 1000 samples were analysed over an 18 month period. No AGA were raised to diagnostic levels, and 2 repeated raised TTG values (> 15 units/ ml) were found in 17 subjects of whom 6 had positive AEA. Fifteen students have undergone endoscopy (6 have positive biopsies for CD), and 2 declined endoscopy.

CONCLUSION:
· The minimum prevalence of CD in young healthcare students in our study is 1:166.
· Our data suggest that Anti-gliadin antibodies are unreliable in detecting CD.
· Furthermore TTG levels of > 80 units/ml appear to be diagnostic of CD.
REFERENCE:
¹Textbook of Paediatrics. Forfar and Arneil. 5th Edition. Churchill Livingstone Press, 2000. Pg 440.