Digestive Diseases and Sciences, Vol. 49, No. 9 (September 2004), pp. 1479–1484 ( C  2004) Screening of Tissue Transglutaminase Antibody in Healthy Blood Donors for Celiac Disease Screening in the Turkish Population GONCA TATAR, MD, RENGIN ELSURER, MD, HALIS SIMSEK, MD, YASEMIN H. BALABAN, MD, GULSEN HASCELIK, MD, OSMAN I. OZCEBE, MD, YAHYA BUYUKASIK, MD, and CENK SOKMENSUER, MD Celiac disease (CD) is a disease having the characteristic pathology of the mucosa of the small intestine. The prevalence of CD in the Turkish population has not been investigated previously. The present study was designed to determine the prevalence of CD in healthy blood donors. Serum samples of 2000 healthy blood donors presenting to Hacettepe University Faculty of Medicine Hospital Blood Bank were tested for tissue transglutaminase (tTG) IgA and IgG antibodies with enzyme- linked immunosorbent assay (ELISA; Euroimmune, Germany). The histopathological findings for the cases with positive serology were evaluated. The distribution of sex was 95.7% male, and 4.3% female. The mean age was 33±9. Among 2000 donors, 23 (1.15%) were positive for tTG IgA antibody and 3 (0.15%) were positive for tTG IgG antibody. None of the samples was positive for both antibodies. Serum total IgA was measured in two cases with only tTG IgG positivity and was found to be low in one case. Twelve subjects positive for tTG agreed to endoscopy and biopsy. Histopathological examination revealed changes classified as Marsh III–II in one, Marsh II in two, Marsh I in seven, and Marsh 0 in two donors. This was the first study conducted to determine the prevalence of tTG positivity in the Turkish population. The tTG antibody positivity prevalence in healthy blood donors was as high as 1.3%. This study shows that the prevalence of CD in the Turkish population is relatively high in comparison to that in the Western world. KEY WORDS: celiac disease; screening; blood donors; tissue transglutaminase; histopathology. Celiac disease (CD) is characterized by malabsorption of nutrients by the small intestine following the ingestion of wheat gluten or related proteins from rye and bar- ley, characteristic villous atrophy of the small intestinal mucosa, clinical and histological recovery after a gluten- free diet, and clinical relapse after the reintroduction of gluten (1–3). An inappropriate inflammatory response to ingested gluten results in an abnormal mucosa of the small intestine (4). Manuscript received MAY 7, 2004; accepted June 14, 2004. From the Department of Internal Medicine, Hacettepe University Medical Faculty Hospital, Ankara, Turkey. Address for reprint requests: Rengin Elsurer, MD, Department of Internal Medicine, Hacettepe University Medical Faculty Hospital, K¨ ult¨ ur Mah. C ¸ alidiran Sok. Park Apt. 11/1, Ankara 06420, Turkey; renginels@hotmail.com. The “iceberg model” was originally defined by Richard Logan in 1991. Screening studies showed that for each CD case diagnosed, 5–10 cases remain undiagnosed and make up the submerged part of the iceberg. The “water line” depends on the awareness of the disease, availabil- ity of diagnostic facilities, and variation of the clinical picture at both the population and the individual levels (5). Diagnosis of the disease is facilitated by the avail- ability of highly specific and sensitive serologic tests (3). Antibodies against gliadin, endomysium, reticulin, tissue transglutaminase (tTG), and jejunum are high in the sera of CD cases (4). The prevalence and the age at presentation of CD have changed over the last 30–40 years. Previously, CD was considered to be a disease of childhood because the ma- jority of the cases were less than 2 years of age. However, Digestive Diseases and Sciences, Vol. 49, No. 9 (September 2004) 1479 0163-2116/04/0900-1479/0 C  2004 Springer Science+Business Media, Inc.