Karimzadhagh Sahand, Abbaspour Elahe, Ghodous Shahriar, Poursadrolah Selvana, Jafari Maryam, Mazloom Sina, Mosavi Mohadese, Makharia Govind K, Rostami-Nejad Mohammad
Celiac Disease and Gluten Related Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Am J Gastroenterol. 2024 Nov 25;120(7):1488-1501. doi: 10.14309/ajg.0000000000003227.
First-degree relatives (FDRs) of patients with celiac disease (CeD) are at high risk for developing CeD. We conducted a systematic review and meta-analysis to estimate CeD prevalence and clinical manifestations by analyzing studies that used the anti-tissue transglutaminase antibody test for screening.
In this systematic review with meta-analysis, studies published in PubMed, Web of Science, Embase, and Scopus were searched up to January 11, 2024, using keywords related to CeD and FDRs. Random-effects models were used, with heterogeneity assessed using the Cochran Q test and the I2 statistic performed in STATA 18.
Of 8,764 studies screened, 34 studies involving 10,016 FDRs of patients with CeD were included. The pooled estimates for seroprevalence and the biopsy-confirmed CeD prevalence in FDRs were 11% (95% CI: 9%-13%) and 7% (95% CI: 6%-9%), respectively. Daughters and sisters had the highest prevalence rates at 23% and 14%, compared with sons and brothers at 6% and 9%, respectively. Regional analysis revealed the highest seroprevalence estimates in Hungary (24%) and Cuba (19%), while the highest prevalence of biopsy-confirmed CeD was reported in Serbia (16%) and the United States (15%). Abdominal pain (42%), bloating (39%), and flatulence (38%) were the most common gastrointestinal symptoms, while 34% of FDRs with CeD were asymptomatic. In addition, pallor was the most frequent nongastrointestinal symptom (54%).
Approximately 1 in 14 FDRs of patients with CeD is estimated to have CeD, with 1 in 4 daughters, 1 in 7 sisters, 1 in 11 brothers, 1 in 16 sons, and 1 in 20 fathers and mothers could be affected. Routine screening for FDRs could support early detection and management of CeD.
乳糜泻（CeD）患者的一级亲属（FDRs）患CeD的风险很高。我们进行了一项系统评价和荟萃分析，通过分析使用抗组织转谷氨酰胺酶抗体检测进行筛查的研究来估计CeD的患病率和临床表现。
在这项包含荟萃分析的系统评价中，检索了截至2024年1月11日在PubMed、科学网、Embase和Scopus上发表的研究，使用了与CeD和FDRs相关的关键词。采用随机效应模型，使用Cochran Q检验评估异质性，并在STATA 18中进行I²统计。
在筛选的8764项研究中，纳入了34项涉及10016名CeD患者FDRs的研究。FDRs中血清学患病率和活检确诊的CeD患病率的合并估计值分别为11%（95%CI：9%-13%）和7%（95%CI：6%-9%）。女儿和姐妹的患病率最高，分别为23%和14%，而儿子和兄弟的患病率分别为6%和9%。区域分析显示，匈牙利（24%）和古巴（19%）的血清学患病率估计最高，而塞尔维亚（16%）和美国（15%）报告的活检确诊CeD患病率最高。腹痛（42%）、腹胀（39%）和肠胃胀气（38%）是最常见的胃肠道症状，而34%的CeD FDRs无症状。此外，面色苍白是最常见的非胃肠道症状（54%）。
估计CeD患者中约每14名FDRs中有1人患有CeD，每4名女儿中有1人、每7名姐妹中有1人、每11名兄弟中有1人、每16名儿子中有1人以及每20名父亲和母亲中有1人可能受到影响。对FDRs进行常规筛查有助于CeD的早期检测和管理。
