Global Prevalence of Celiac Disease and Clinical Characteristics in the General Population: A Systematic Review and Meta-Analysis.

BACKGROUND & AIMS: Celiac disease (CeD) is a global issue; its burden was detailed in a systematic review almost 8 years ago. Since then, new studies have emerged, prompting an update on prevalence estimates. We also aimed to characterize clinical features and assess how diagnostic methods influence detection rates.

METHODS

We conducted a systematic review and meta-analysis of CeD prevalence in the general population, searching MEDLINE, Embase, Web of Science, and Scopus from inception until April 2024. Included studies used tissue transglutaminase IgA antibodies with or without biopsy confirmation, endomysial antibodies, and deamidated gliadin peptide antibodies. Random-effects models were used to pool prevalence estimates by diagnostic methods and demographic factors.

RESULTS

We included 87 articles, comprising 394,274 participants. Global seroprevalence was 1.5% (95% CI, 1.3%-1.8%; I2 = 97.1%) and biopsy-confirmed prevalence of CeD was 0.8% (95% CI, 0.6%-1.0%; I2 = 94.9%). Using multiple serologic tests increased seropositivity by 40%, reaching 2.1%. Regarding IgA deficiency, adding deamidated gliadin peptide IgG raised seroprevalence by 120% to 2.2%. Prevalence was 50% higher in females and nearly doubled in children. Although seroprevalence was highest in Oceania and North America, biopsy-confirmed CeD was highest in Europe and South America. High-income countries had the highest prevalence; 36.6% of seropositive individuals did not undergo biopsy. Among biopsied patients, 30.8% met potential CeD criteria and 41.4% of biopsy-confirmed patients were asymptomatic.

CONCLUSIONS

The present evidence indicates that approximately 1 in 70 individuals globally is seropositive for CeD and 1 in 120 has biopsy-confirmed CeD. Approximately 41% are asymptomatic, highlighting the need for improved detection worldwide.