"Early" vs. "late" diagnosis of celiac disease in two ethnic groups living in the same geographic area.

Despite studies documenting existence of celiac disease worldwide, its prevalence in many parts of the world is underestimated and cases remain unrecognized. In Israel, celiac disease is relatively common among the Jewish population but considered to be rarer among the Arab population. We compared the manifestations of celiac disease in children of both ethnic groups and questioned whether differences in presentation relate to degree of awareness for celiac disease in each group. Age at presentation, time interval between onset of symptoms and diagnosis, prevalence of gastrointestinal symptoms, presence of signs of malabsorption and degree of growth retardation varied markedly between both groups. In populations in which there is a low index of suspicion for celiac disease, symptoms may be wrongly attributed to the post-gastroenteritis syndromes or protein-calorie malnutrition, thus resulting in a detrimental delay in diagnosis. Undiagnosed cases may in later childhood manifest predominantly as short stature.