A new report released by an international group of researchers finds that pediatric celiac disease varies by region, suggesting that there are different “environmental, genetic, and epigenetic (the way behaviors and environment affect how genes work) influences even within the United States,” and recommending a “low threshold for screening and further research on region-specific celiac disease triggers.”

It is important for researchers to identify what may be contributing to how the disease occurs differently among regions “because determining the risk factors (genetic, environmental, epigenetic, etc.) can help us better understand the disease and can also help inform future preventive strategies,” said Marisa Stahl, MD, one of the study authors and a Celiac Disease Foundation Research Grant Award Recipient currently practicing at Children’s Hospital Colorado Center for Celiac Disease.

As part of The Environmental Determinants of Diabetes in the Young (TEDDY) study, children at genetic risk for both type 1 diabetes and celiac disease (CeD) in the United States, Finland, Germany, and Sweden are also monitored for celiac disease autoimmunity (CDA) by assessment of autoantibodies to tissue transglutaminase (tTGA). In simple terms, “celiac disease autoimmunity is evidence of an immune response based on tTG antibody screening without additional bloodwork confirmation or biopsy confirmation of celiac disease,” Stahl said.

Researchers found, based on their study published in The American Journal of Gastroenterology, that over the course of 10 years, the highest number of people developing CDA or CeD happened in Sweden, at 8.4%  and 3%, respectively. In the U.S., Colorado ranked highest at 6.5% for CDA and 2.4% for CeD, and the lowest overall occurrence worldwide was in Washington state, with 4.6% for CDA and 0.9% for CeD.

Researchers state that “individuals may have CDA without having CeD (sic) if they have transient or fluctuating antibody levels, low antibody levels without biopsy evaluation, dietary modification influencing further evaluation, or potential celiac disease.”

While the study stops short of recommending mass screening for celiac disease, as more information is needed on the cost effectiveness of such strategies and how mass screening compares with the current screening, researchers write that “…this points to the importance for clinicians to have a low threshold for CeD screening in the appropriate clinical setting.”

The complete study is available for review in The American Journal of Gastroenterology.