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Coeliac Disease in the Maltese Islands Thomas M Attard MD FAAP FACG Consultant Paediatrician and gastroenterologist Mater Dei Hospital, BKara, Malta.

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Presentation on theme: "Coeliac Disease in the Maltese Islands Thomas M Attard MD FAAP FACG Consultant Paediatrician and gastroenterologist Mater Dei Hospital, BKara, Malta."— Presentation transcript:

1 Coeliac Disease in the Maltese Islands Thomas M Attard MD FAAP FACG Consultant Paediatrician and gastroenterologist Mater Dei Hospital, BKara, Malta

2 The Maltese Islands - statistics Surface area316 km2 Population 413,609 Population density 1,309 Live births 4,126 : Crude birth rate 10.0 GDP 5,758.8 million Registered medical practitioners 1,374 (persons per sq. km.)

3 The Maltese Diet wheat products (bread and pasta), and rice are the major source of energy in the Maltese diet contributing a third to the total energy The staple cereal in Malta is wheat, mainly as bread (78%) and then, mainly as local white bread (99%). Pasta contributes 11% to the total purchase of cereal products. Multigrain and brown bread appear to be becoming more popular. Bellizzi, M. (1992).The Maltese Food Revolution : An analysis of the eating habits in Malta. Technical Report of the Malta Case Study for the International Conference on Nutrition, Department of Health, Valletta.

4 Dietary trends are geared toward 'healthy' eating: low fat, low clarorie diet with more fish and less beef-pork Socioeconomic pressures still promote bread and pastry based foods as cheap, convenient and easily accessible. The Maltese Diet

5 Regional distribution of Coeliac Disease in the Maltese Islands* * Crude prevalence individuals receiving benefits for GFD

6 Clinical Case recognition in the Maltese Islands Prevalence of CD based on clinical diagnosis & GFD: 1.9 / 1,000 (1 in 526 gen. Pop n ) Older age at diagnosis of paediatric cases C. Vella, V Grech Ind. J Peds 2004 cf Analogous population based study (clincal presentation / GFD) from Sicily - prevalence 1.65/1,000; adjusted actual standardized rate 3 /1,000. cf worldwide average 1:3345, on clinical, 1:266 on screening data Fasano & Catassi, Gastroenterology 2001; 120: Magazzú G, et al. Acta Paediatr. 1994;83(10):

7 Age at diagnosis distribution, Coeliac patients in the Maltese Islands

8 Age at diagnosis distribution by gender of Coeliacs in the Maltese Islands

9 The Maltese Islands – Tourists with Coeliac Disease Tourist arrivals 1.3 million Average tourist length of stay 8.5 nights A minority of restaurants, most 5-star establishments offer gluten-free meals Gluten free menus not yet established

10 Coeliac Association Malta Founded 1989 Currently has 307 active members and 288 ex- members (defaulted / otherwise) Frequency of CD membership 1:1,347 cf Europe 1:2,377 Supports members wrt issues pertaining to the day to day management of coeliac disease facilitates government-provided assistance and monitors restaurant and food-outlet coeliac-friendliness A. Catassi, A. Fasano. Curr Gastroenterol Rep 2002;4:

11 CD in Malta – diagnosis Serology: tTG IgA, tTG IgG –Limited accessibility of Total serum IgA Screening at risk populations – recognized (but no standardized approach) Asymptomatic relatives Downs (8%), Turner & Williams syndrome Schiberras C. et al. Ann. Trop. Peds, 2004 T ype 1 diabetes Autoimmune Thyroiditis Biopsy: endoscopy / Cosby Capsule Inconclusive findings can be further studied through capsule endoscopy

12 CD in Malta – opportunities in Education and Case Recognition Patient education: seminars / association website / leaflets Public education efforts Caregiver education: medical / nursing school, postgraduate education; background, curriculum

13 CD in Malta; management - limitations Nutrition support services in the community / through MDH Time to new appointment, waiting list for follow up appointments at MDH – nutritionist services highly variable Limited resources in numbers of government-employed nutritionists – no dedicated child / coeliac specialization Legislation - enforcement regarding the correct labeling of food

14 CD in Malta; future needs and opportunities Easier access to specialist care and nutritionist consultation Merging legislation, EU mandated standards and monitoring – enforcement Standardized protocol for screening at risk populations and streamlined referral

15 Education and Academics National awareness programs Public oriented Provider oriented Genetic testing & research initiatives novel gene mechanisms in Maltese CD families (non-HLA, CD 59, CD 44 coinheritance) Vidal C. et al. Tiss. Antigens 2009 Support for pertinent patient support resources

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