A P value of less than 0.05 was considered statistically significant. disease, the overall prevalence of celiac serology positive in this community sample was 0.8%. All 31 subjects were offered a small bowel biopsy. Seventeen of the 18 biopsied subjects (94%) had at least partial villous atrophy. Symptoms that were reported by the fair attendees did not predict positivity. Conclusions Screening for celiac disease was widely accepted in this preventative healthcare setting. Undiagnosed celiac disease affects 1 in 126 individuals in this Wyoming community. Most were asymptomatic or had atypical presentations. Serologic testing can readily detect this disease in a general population. INTRODUCTION The prevalence of suspected celiac disease in Western nations varies from 1 in 87 to 1 1 in 500 individuals.1C5 The prevalence of diagnosed celiac disease is much lower, however, being somewhere between 1 in 500 and 1 in 9,000 individuals.6C8 In the past, diagnosis has been more frequent in patients with classic symptoms, such as diarrhea, steatorrhea, weight loss or failure to thrive, and multiple vitamin deficiencies.9 Increasing awareness of the condition and availability of serologic tests have led to augmented case finding,10C12 with a corresponding change in the types of presentations that lead to the diagnosis. Consequently, an increasing proportion of patients without classic features of malabsorption or diarrheal illness have been identified.8,13 For many years, celiac disease has been considered rare in the United States even though an increased frequency of celiac Rabbit Polyclonal to GSK3beta disease was being GM 6001 reported in European countries. 14 Recently a large multi-center study in the United States, that included a substantial cohort of subjects regarded as healthy, suggested a celiac disease prevalence of 1 1 in 133.15 However, there has been much debate about the most efficient strategy for detecting these additional celiac disease cases.16,17 If physicians only test those with severe, classic, malabsorptive symptoms, patients with atypical symptoms, who make up the majority of cases, would be missed; even testing those in whom celiac disease is more likely to occur (e.g., those with an affected family member, iron deficient anemia, type one diabetes, or premature osteoporosis) will miss most cases.18 Other than some well defined clinical associations,9 little is known about the symptoms that may provide clues to early diagnosis. In this regard, it has been suggested that the presence of symptoms suggestive of IBS may predict celiac disease,20C23 but this has remained controversial. However based on cost-benefit considerations and lack of an ideal screening strategy for celiac disease, to date a case-finding approach rather than population screening has been advocated by others.12, 24 The aims of this study were to determine the prevalence of undiagnosed celiac disease in a large population of adults in a geographically predefined area, and to identify any symptoms that predict celiac disease. Our secondary aim was to determine the efficiency and acceptability of screening for celiac disease in a health fair setting. SUBJECTS AND METHODS Study Design Annual health fairs have been a longstanding practice and a traditional mode of providing preventative health care and information in Wyoming. This practice grew out of the seminal studies on community-based testing and treatment of streptococcal infection in the 1950s.25 Traditionally, there has been wide participation of the adult population in these fairs, which provide information regarding disease-specific prevention and low cost tests for health screening purposes. This study took advantage of the well-established health fair in Natrona County, Wyoming. This county is a mixed urban and rural community of approximately 66,500 individuals (~49,000 adults) that is 91% Caucasian with the rest predominantly Hispanic or American Indian (US census 2000). This site was chosen for several reasons: First, it is geographically isolated, with virtually all hospital-based care being delivered by GM 6001 the Wyoming Medical Center. Secondly, there is a single GI practice that provides most of the gastrointestinal consultation and endoscopy services for the area, allowing prevalent cases of celiac disease to be readily enumerated. Lastly, there is a very active support group available for the patients with celiac disease in the area. The laboratory component of the Health Fairs consisted of offering GM 6001 routine screening blood tests to individuals on an appointment basis. Individual participants select from a menu of tests. Typically, these tests include prostate specific antigen, cholesterol, homocysteine, hemoglobin and.