Prevalence of Celiac Disease in China: Meta-analysis and Serological Survey in High-risk Populations

Objective To perform a meta-analysis that investigates the prevalence and seroprevalence of celiac disease (CD) in Chinese general population and high-risk populations, and to summarize data from a serological survey of high-risk populations in Guangdong, China. Methods We collected data from the serological survey of high-risk populations in Guangdong, China (n = 1390) by testing serum tissue transglutaminase immunoglobulin A (tTG-IgA), deamidated gliadin peptides immunoglobulin A (DGP-IgA) and deamidated gliadin peptides immunoglobulin G (DGP-IgG), and also searched Medline, PubMed, Embase, Cochrane and 3 Chinese databases up to December 20, 2020 to estimate the pooled prevalence and seroprevalence of CD in China. Results In the serological survey, 0.94% (13/1390) individuals were positive for CD antibodies. In a meta-analysis of 18 studies, the seroprevalence of CD in Chinese general population was 0.27% (95% CI, 0.02-0.71). The seroprevalence of CD in Chinese high-risk populations was 8.34% (95% CI, 4.90-12.54), significantly higher than that in general population (OR 7.27, 95% CI, 4.06-13.04). The prevalence of biopsied-proven CD in high-risk Chinese populations was 4.44% (95% CI, 1.53-8.58). The seroprevalence of CD was varying with geographic origin, higher in Northern China than that in Southern China. Conclusions The basis for diagnosis of CD in Chinese patients should be through early case-finding by serological screening in high-risk groups; generous serological testing in patients with vague symptoms, especially in Northern Chinese.