Global Prevalence of Celiac Disease and Clinical Characteristics in the General Population: A Systematic Review and Meta-analysis.

BACKGROUND AND AIMS: Celiac disease (CeD) is a global issue, with its burden detailed in a systematic review almost 8 years ago. Since then, new studies have emerged, prompting an update on prevalence estimates. We also aimed to characterize clinical features and assess how diagnostic methods influence detection rates. METHODS: We conducted a systematic review and meta-analysis of CeD prevalence in the general population, searching MEDLINE, Embase, Web of Science, and Scopus from inception until April 2024. Included studies used tissue transglutaminase antibodies(tTG-IgA) with or without biopsy confirmation, endomysial antibodies (EMA) and deamidated gliadin peptide (DGP) antibodies. Random-effects models were used to pool prevalence estimates by diagnostic methods and demographic factors. RESULTS: We included 87 articles, comprising 394,274 participants. Global seroprevalence was 1.5% (95% CI: 1.3-1.8%; I2=97.1%), and biopsy-confirmed prevalence of CeD was 0.8% (95% CI: 0.6-1.0%; I2=94.9%). Using multiple serologic tests increased seropositivity by 40%, reaching 2.1%. Regarding IgA deficiency, adding DGP-IgG raised seroprevalence by 120% to 2.2%. Prevalence was 50% higher in females and nearly doubled in children. While seroprevalence was highest in Oceania and North America, biopsy-confirmed CeD was highest in Europe and South America. High-income countries showed the highest prevalence. 36.6% of seropositive individuals did not undergo biopsy. Among biopsied patients, 30.8% met potential CeD criteria, and 41.4% of biopsy-confirmed patients were asymptomatic. CONCLUSION: The present evidence indicates that about 1 in 70 individuals globally is seropositive for CeD, and 1 in 120 has biopsy-confirmed CeD. Approximately 41% are asymptomatic, highlighting the need for improved detection worldwide.