Screening for Celiac Screening for Celiac Disease In Rural Disease In Rural Areas in EgyptAreas in Egypt

Prof. Dr: Mona Abu Zekry

Cairo University

Situation of CD In Situation of CD In EGYPTEGYPT

Until the year 2000 Celiac Until the year 2000 Celiac Disease was almost unknown in Disease was almost unknown in Egypt. Although symptoms and Egypt. Although symptoms and signs of CD are very common in signs of CD are very common in the Egyptian population, the Egyptian population, children as well as adults, it is children as well as adults, it is very rarely put in the very rarely put in the differential diagnosis.differential diagnosis.

A previous pilot study done by our group A previous pilot study done by our group in 2008 showed:in 2008 showed:

Out of the total 1500 cases studied, 21 Out of the total 1500 cases studied, 21 cases were found to be positive for cases were found to be positive for celiac disease.celiac disease.

This represents prevalence of 1.4%.This represents prevalence of 1.4%. Prevalence detected in different Prevalence detected in different

serological studies conducted worldwide serological studies conducted worldwide ranges from 0.5% - 1.5% (Dubé ranges from 0.5% - 1.5% (Dubé et.al.,2005).et.al.,2005).

Map Of EgyptMap Of Egypt

Egypt is mainly a rural and Egypt is mainly a rural and agricultural country. Above seventy agricultural country. Above seventy percent of the population live in the percent of the population live in the rural areas out of 85 million ,around rural areas out of 85 million ,around sixty million.sixty million.

In Egypt the main bulk of cases with In Egypt the main bulk of cases with acute gastroenteritis and malnutrition acute gastroenteritis and malnutrition is due to infective and chronic is due to infective and chronic diarrhea. In the middle of these cases diarrhea. In the middle of these cases are certainly many children with are certainly many children with undiagnosed Celiac Disease.undiagnosed Celiac Disease.

To screen for Celiac Disease in To screen for Celiac Disease in the rural areas we will choose the rural areas we will choose two or three villages near two or three villages near Cairo.Cairo.

There are health care units There are health care units where mothers and children where mothers and children are recorded and can be are recorded and can be recruited for health education recruited for health education and physical assessment.and physical assessment.

Health Care Unit In EgyptHealth Care Unit In Egypt

We can recruit 5000 mother and children We can recruit 5000 mother and children and detect the symptomatic patients and detect the symptomatic patients suffering from:suffering from:

Chronic diarrhea/abnormal stool/Irregular Chronic diarrhea/abnormal stool/Irregular bowel function bowel function

Weight loss/Failure to thrive/ Short statureWeight loss/Failure to thrive/ Short stature Anorexia/ lack of appetiteAnorexia/ lack of appetite VomitingVomiting Globous abdomenGlobous abdomen Abdominal painAbdominal pain AnaemiaAnaemia ConstipationConstipation Asthenia/ irritabilityAsthenia/ irritability

We can do a rapid tTg test to spot the cases.We can do a rapid tTg test to spot the cases.

For confirmation we will take serum from For confirmation we will take serum from these cases and do all the serological tests these cases and do all the serological tests needed.needed.

Positive cases will be offered intestinal Positive cases will be offered intestinal biopsy.biopsy.

Another group with no sypmtoms ( normal Another group with no sypmtoms ( normal school children) will be taken as controls.school children) will be taken as controls.

This will give a good indication of the This will give a good indication of the prevalence of CD among Egyptian childrenprevalence of CD among Egyptian children

School Children in EgyptSchool Children in Egypt

For positive cases, genetic studies and For positive cases, genetic studies and examination of family members will be examination of family members will be offered.offered.

If resources are available, the same If resources are available, the same procedure can be done in urban areas and procedure can be done in urban areas and we would have results of 10000 we would have results of 10000 individuals.individuals.

The next step would be to provide The next step would be to provide educational and social support through an educational and social support through an International Celiac Disease Foundation International Celiac Disease Foundation and the production of suitable gluten free and the production of suitable gluten free nutrition.nutrition.

Health Education In Health Education In EgyptEgypt