Sex Difference in Celiac Disease in Undiagnosed Populations: A Systematic Review and Meta-analysis

Claire L. Jansson-Knodell, Isabel A. Hujoel, Colin Patrick West, Veena D Taneja, Larry J. Prokop, Alberto Rubio-Tapia, Joseph A Murray

Research output: Contribution to journalArticle

Abstract

Background & Aims: A higher proportion of female vs male patients receive a diagnosis of celiac disease. Little is known about sex-based differences in the prevalence of celiac disease in undiagnosed populations. We aimed to address this knowledge gap with a systematic review and meta-analysis. Methods: We searched MEDLINE, Embase, Cochrane, and Scopus databases through 2017 for studies of screen-detected or undiagnosed celiac disease. Our final analysis included studies that included screening and confirmatory tests (either second serologic analysis or a small intestine biopsy) and provided information on the sex of participants. Studies were excluded if they were performed with specific, high-risk, or referral populations. The primary outcome was the percentage of undetected celiac disease among female and male patients. Results: We identified 4070 articles and analyzed data from 87. Our meta-analysis comprised data from 291,969 study participants. The pooled prevalence of undetected celiac disease in female participants was 0.589% (95% CI, 0.549%–0.629%) and in male participants was 0.415% (95% CI, 0.343%–0.487%). The risk of undetected celiac disease was higher among female than male participants (relative risk [RR], 1.42; 95% CI, 1.27–1.57; P <.00001). The I2 was 5% (low heterogeneity among studies). In subgroup analyses, the RR of celiac disease for girls vs boys was 1.79 (95% CI, 1.44–2.22; P <.00001; I2 = 18%), the RR for female vs male blood donors was 1.13 (95% CI, 0.76–1.69; P =.54; I2 = 0), and the RR for women vs men with villous atrophy was 1.38 (95% CI, 1.07–1.79; P =.01; I2 = 0). Conclusions: In a systematic review and meta-analysis, we found a higher risk for celiac disease in women than men in an undiagnosed populations (identified through general population screening). The increased risk for celiac disease among girls and women should be considered for screening, diagnosis, and management strategies.

Original languageEnglish (US)
Pages (from-to)1954-1968.e13
JournalClinical Gastroenterology and Hepatology
Volume17
Issue number10
DOIs
StatePublished - Sep 1 2019

Fingerprint

Celiac Disease
Sex Characteristics
Meta-Analysis
Population
Blood Donors
MEDLINE
Small Intestine
Atrophy
Referral and Consultation
Databases
Biopsy

Keywords

  • Biopsy
  • Epidemiology
  • Gender
  • Sprue

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Sex Difference in Celiac Disease in Undiagnosed Populations : A Systematic Review and Meta-analysis. / Jansson-Knodell, Claire L.; Hujoel, Isabel A.; West, Colin Patrick; Taneja, Veena D; Prokop, Larry J.; Rubio-Tapia, Alberto; Murray, Joseph A.

In: Clinical Gastroenterology and Hepatology, Vol. 17, No. 10, 01.09.2019, p. 1954-1968.e13.

Research output: Contribution to journalArticle

Jansson-Knodell, Claire L. ; Hujoel, Isabel A. ; West, Colin Patrick ; Taneja, Veena D ; Prokop, Larry J. ; Rubio-Tapia, Alberto ; Murray, Joseph A. / Sex Difference in Celiac Disease in Undiagnosed Populations : A Systematic Review and Meta-analysis. In: Clinical Gastroenterology and Hepatology. 2019 ; Vol. 17, No. 10. pp. 1954-1968.e13.
@article{2ad4b7e35fcb4d849656a4702d6a8bbe,
title = "Sex Difference in Celiac Disease in Undiagnosed Populations: A Systematic Review and Meta-analysis",
abstract = "Background & Aims: A higher proportion of female vs male patients receive a diagnosis of celiac disease. Little is known about sex-based differences in the prevalence of celiac disease in undiagnosed populations. We aimed to address this knowledge gap with a systematic review and meta-analysis. Methods: We searched MEDLINE, Embase, Cochrane, and Scopus databases through 2017 for studies of screen-detected or undiagnosed celiac disease. Our final analysis included studies that included screening and confirmatory tests (either second serologic analysis or a small intestine biopsy) and provided information on the sex of participants. Studies were excluded if they were performed with specific, high-risk, or referral populations. The primary outcome was the percentage of undetected celiac disease among female and male patients. Results: We identified 4070 articles and analyzed data from 87. Our meta-analysis comprised data from 291,969 study participants. The pooled prevalence of undetected celiac disease in female participants was 0.589{\%} (95{\%} CI, 0.549{\%}–0.629{\%}) and in male participants was 0.415{\%} (95{\%} CI, 0.343{\%}–0.487{\%}). The risk of undetected celiac disease was higher among female than male participants (relative risk [RR], 1.42; 95{\%} CI, 1.27–1.57; P <.00001). The I2 was 5{\%} (low heterogeneity among studies). In subgroup analyses, the RR of celiac disease for girls vs boys was 1.79 (95{\%} CI, 1.44–2.22; P <.00001; I2 = 18{\%}), the RR for female vs male blood donors was 1.13 (95{\%} CI, 0.76–1.69; P =.54; I2 = 0), and the RR for women vs men with villous atrophy was 1.38 (95{\%} CI, 1.07–1.79; P =.01; I2 = 0). Conclusions: In a systematic review and meta-analysis, we found a higher risk for celiac disease in women than men in an undiagnosed populations (identified through general population screening). The increased risk for celiac disease among girls and women should be considered for screening, diagnosis, and management strategies.",
keywords = "Biopsy, Epidemiology, Gender, Sprue",
author = "Jansson-Knodell, {Claire L.} and Hujoel, {Isabel A.} and West, {Colin Patrick} and Taneja, {Veena D} and Prokop, {Larry J.} and Alberto Rubio-Tapia and Murray, {Joseph A}",
year = "2019",
month = "9",
day = "1",
doi = "10.1016/j.cgh.2018.11.013",
language = "English (US)",
volume = "17",
pages = "1954--1968.e13",
journal = "Clinical Gastroenterology and Hepatology",
issn = "1542-3565",
publisher = "W.B. Saunders Ltd",
number = "10",

}

TY - JOUR

T1 - Sex Difference in Celiac Disease in Undiagnosed Populations

T2 - A Systematic Review and Meta-analysis

AU - Jansson-Knodell, Claire L.

AU - Hujoel, Isabel A.

AU - West, Colin Patrick

AU - Taneja, Veena D

AU - Prokop, Larry J.

AU - Rubio-Tapia, Alberto

AU - Murray, Joseph A

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Background & Aims: A higher proportion of female vs male patients receive a diagnosis of celiac disease. Little is known about sex-based differences in the prevalence of celiac disease in undiagnosed populations. We aimed to address this knowledge gap with a systematic review and meta-analysis. Methods: We searched MEDLINE, Embase, Cochrane, and Scopus databases through 2017 for studies of screen-detected or undiagnosed celiac disease. Our final analysis included studies that included screening and confirmatory tests (either second serologic analysis or a small intestine biopsy) and provided information on the sex of participants. Studies were excluded if they were performed with specific, high-risk, or referral populations. The primary outcome was the percentage of undetected celiac disease among female and male patients. Results: We identified 4070 articles and analyzed data from 87. Our meta-analysis comprised data from 291,969 study participants. The pooled prevalence of undetected celiac disease in female participants was 0.589% (95% CI, 0.549%–0.629%) and in male participants was 0.415% (95% CI, 0.343%–0.487%). The risk of undetected celiac disease was higher among female than male participants (relative risk [RR], 1.42; 95% CI, 1.27–1.57; P <.00001). The I2 was 5% (low heterogeneity among studies). In subgroup analyses, the RR of celiac disease for girls vs boys was 1.79 (95% CI, 1.44–2.22; P <.00001; I2 = 18%), the RR for female vs male blood donors was 1.13 (95% CI, 0.76–1.69; P =.54; I2 = 0), and the RR for women vs men with villous atrophy was 1.38 (95% CI, 1.07–1.79; P =.01; I2 = 0). Conclusions: In a systematic review and meta-analysis, we found a higher risk for celiac disease in women than men in an undiagnosed populations (identified through general population screening). The increased risk for celiac disease among girls and women should be considered for screening, diagnosis, and management strategies.

AB - Background & Aims: A higher proportion of female vs male patients receive a diagnosis of celiac disease. Little is known about sex-based differences in the prevalence of celiac disease in undiagnosed populations. We aimed to address this knowledge gap with a systematic review and meta-analysis. Methods: We searched MEDLINE, Embase, Cochrane, and Scopus databases through 2017 for studies of screen-detected or undiagnosed celiac disease. Our final analysis included studies that included screening and confirmatory tests (either second serologic analysis or a small intestine biopsy) and provided information on the sex of participants. Studies were excluded if they were performed with specific, high-risk, or referral populations. The primary outcome was the percentage of undetected celiac disease among female and male patients. Results: We identified 4070 articles and analyzed data from 87. Our meta-analysis comprised data from 291,969 study participants. The pooled prevalence of undetected celiac disease in female participants was 0.589% (95% CI, 0.549%–0.629%) and in male participants was 0.415% (95% CI, 0.343%–0.487%). The risk of undetected celiac disease was higher among female than male participants (relative risk [RR], 1.42; 95% CI, 1.27–1.57; P <.00001). The I2 was 5% (low heterogeneity among studies). In subgroup analyses, the RR of celiac disease for girls vs boys was 1.79 (95% CI, 1.44–2.22; P <.00001; I2 = 18%), the RR for female vs male blood donors was 1.13 (95% CI, 0.76–1.69; P =.54; I2 = 0), and the RR for women vs men with villous atrophy was 1.38 (95% CI, 1.07–1.79; P =.01; I2 = 0). Conclusions: In a systematic review and meta-analysis, we found a higher risk for celiac disease in women than men in an undiagnosed populations (identified through general population screening). The increased risk for celiac disease among girls and women should be considered for screening, diagnosis, and management strategies.

KW - Biopsy

KW - Epidemiology

KW - Gender

KW - Sprue

UR - http://www.scopus.com/inward/record.url?scp=85070933630&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070933630&partnerID=8YFLogxK

U2 - 10.1016/j.cgh.2018.11.013

DO - 10.1016/j.cgh.2018.11.013

M3 - Article

C2 - 30448593

AN - SCOPUS:85070933630

VL - 17

SP - 1954-1968.e13

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

IS - 10

ER -