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Coeliac disease
Screening for coeliac disease in children and adults living in a slum of Dhaka, Bangladesh
  1. Md. Amran Gazi1,
  2. Subhasish Das1,
  3. Mustafa Mahfuz1,
  4. Md. Mehedi Hasan1,
  5. Md. Shabab Hossain1,
  6. Shah Mohammad Fahim1,
  7. Md. Ashraful Alam1,
  8. Zannatun Noor1,
  9. Carol A Gilchrist2,
  10. William A Petri2,
  11. M Masudur Rahman3,
  12. Ramendra Nath Mazumder1,
  13. Rashidul Haque1,
  14. Shafiqul Alam Sarker1,
  15. Tahmeed Ahmed1
  1. 1Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
  2. 2Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, Virginia, USA
  3. 3Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh
  1. Correspondence to Md. Amran Gazi, ICDDRB, Dhaka, Bangladesh; amran.gazi{at}icddrb.org

Abstract

Background and objective Serological screening with a confirmation through biopsy has improved the understanding of coeliac disease (CD) epidemiology worldwide. Prevalence of CD in Bangladesh is not yet explored and therefore, we aimed to assess the seroprevalence of CD in slum-dwelling malnourished children and adults in Dhaka.

Methods Serum samples were collected from three different cohorts: stunted (length-for-age Z-scores (LAZ) <−2) and at risk of stunting children (LAZ <−1 to −2) and malnourished adults (body mass index <18.5 kg/m2). Samples from all the participants were assessed for anti-tissue transglutaminase antibody (tTG-IgA) and total serum IgA by ELISA. Positive tTG-IgA and randomly selected low IgA values were reconfirmed using anti-tTG-IgG and gliadin IgG ELISA. CD was diagnosed when second screening tests were found positive and the participants were further investigated by small bowel biopsy.

Results A total of 818 participants (240 stunted, 272 at risk of stunting children and 306 malnourished adults) were enrolled in the study. Overall, anti-tTG-IgA was positive in 5/818 (0.6%; 95% CI 0.25% to 1.46%). Of the five positive cases, anti-tTG-IgG and gliadin IgG were found positive in only one participant. Duodenal biopsy of positive participant revealed characteristic lesions of CD. Randomly selected low IgA values were found negative in tTG-IgG and gliadin IgG for all the participants. No participant was found total IgA deficient.

Conclusion The incidence of coeliac autoimmunity is low in malnourished slum dwellers regardless of age in Bangladesh. It is important to investigate the nationwide prevalence to reveal the definite picture.

  • coeliac disease
  • prevalence
  • bangladesh
  • ELISA
  • serology

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplementary information.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjgast-2019-000294

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplementary information.

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    Footnotes

    • Contributors TA originated the idea for the study and led the protocol design. AG, SD, MM and TA participated in the design of the study. AG, MH, SH, SMF, AA, ZN, CAG, WAP, MMR, RNM, RH, SAS and TA conducted the study and supervised the sample and data collection. AG, MH and SD performed and supervised the sample analysis. AG, SD, MM and TA were involved in data analysis. AG, WAP, MMR, RNM, RH, SAS and TA interpreted the results. AG, SD, MM and TA were involved in manuscript writing. All authors read and approved the final manuscript.

    • Funding This study was funded by Bill and Melinda Gates Foundation under its Global Health Program (https://www.gatesfoundation.org/How-WeWork/Quick-Links/GrantsDatabase%23q/year=2015&amp;program=Global). Project investment id is OPP1136751.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.