Lower economic status and inferior hygienic environment may protect against celiac disease

Figures & data

Table I. Characteristics of the 12 Russian‐Karelian children who tested positive for tTGA in the primary screening; 8 of these children underwent endoscopy and small‐bowel biopsy to confirm the diagnosis of celiac disease (cases 1–8), while 4 children did not undergo endoscopy (cases 9–12).

Case	Gender	Ab screening ^a		Ab at endoscopy		Biopsy					HLA‐type ^c		Symptoms	Diagnosis
		tTGA (U/mL)	EMA	tTGA (U/mL)	EMA	IgA deposit	Morphology	CD3 (cells/mm) ^b	α/β (cells/mm) ^b	γ/δ (cells/mm) ^b	DQB1*	DQA1*
Biopsy sample available:
1.	F	56	1:1000	34	1:200	3+	Total atrophy	46	36	26	0301,0302		Abdominal pain, flatulence, neurodermatitis	Celiac
2.	F	42	1:200	28	1:500	2+	Total atrophy	89	70	39	02,0301	05,0201	Abdominal pain, flatulence, vomiting, anemia	Celiac
3.	M	10	1:100	3	0	1–2+	Total atrophy	81	51	21	02,02	05,0201	Abdominal pain, diarrhea, vitiligo	Celiac
4.	M	30	1:500	41	1:200	neg	Partial atrophy	19	18	0	02,0301	05	Asthma, allergic dermatitis	Celiac
5.	F	6	0	6	0	1–2+	Nonspecific inflammation	76	23	34	02,0301	05,0201	No symptoms	Nonceliac
6.	F	6	1:5	1	0	neg	Normal	33	22	15	02,0301	05	No symptoms	Nonceliac
7.	F	6	0	0	0	neg	Normal	23	22	7	02,0602	0201	No symptoms	Nonceliac
8.	F	6	0	0	0	neg	Normal	ND	ND	ND	02,02	05,0201	Tiredness, recurrent abdominal pain	Nonceliac
Biopsy sample not available:
9.	F	38	1:500	–	–	–	–	–	–	–	02,0602	05	No symptoms	ND
10.	F	31	1:1000	–	–	–	–	–	–	–	02,0602	05	No symptoms	ND
11.	F	10	1:100	–	–	–	–	–	–	–	02,0301	05,0201	No symptoms	ND
12.	F	5	1:5	–	–	–	–	–	–	–	02,0302	03,0201	No symptoms	ND

ND = not determined; – = no sample; Ab = antibody.

^a Cutoff levels for serum antibody positivity: tissue transglutaminase antibodies (tTGA) >5 U/mL, endomysial antibodies (EMA)⩾1:5.

^b The densities of T‐cell receptor‐bearing intraepithelial lymphocytes (IELs): reference values for CD3⁺ IELs <37 cells/mm, for α/β⁺ IELs <25 cells/mm, and for γ/δ⁺ IELs <4.3 cells/mm.

^c Cases 3, 4, 6, 8, 9, and 10 carry the HLA‐DR3‐DQ2/x genotype; cases 2, 5, and 11 carry the HLA‐DR5‐DQ7/DR7‐DQ2 genotype; case 1 and 12 carry the HLA‐DR4‐DQ8/y genotype; case 7 carries another HLA genotype.

Figure 1 Screening protocol for celiac disease based on the measurement of IgA‐class tissue transglutaminase antibodies (tTGA) in the two study populations followed by small‐bowel biopsy in tTGA‐positive subjects.

Figure 2 Frequency of different human leukocyte antigen(HLA) genotypes in schoolchildren in Russian Karelia (black bars) and in Finland (white bars). Altogether 1977 Russian‐Karelian and 3649 Finnish children were HLA‐typed (X = other than DQ7 or DQ8; Y = other than DQ2; n = absolute number of children carrying different HLA genotypes).