Background: Celiac disease is a systemic immune-mediated disorder that develops in genetically predisposed individuals following the consumption of gluten and prolamins found in wheat and barley. The prevalence of celiac disease has increased significantly due to greater physician awareness and the use of highly sensitive diagnostic tests. Despite this growing awareness and widespread use of diagnostic methods, celiac disease still remains undiagnosed in many individuals. This study aimed to determine the prevalence and clinical manifestations of CD in Sabzevar County, Iran.

Methods: This cross-sectional study reviewed medical records of 2,000 patients referred to Heshmatieh Hospital, Sabzevar. Patients with symptoms suggestive of CD or with type 1 diabetes underwent serological testing (anti-tTG, total IgA). Those with positive serology underwent duodenal biopsy, classified according to the Marsh criteria. Demographic and clinical data were analyzed using SPSS.

Results: Among 306,310 residents of Sabzevar County, 54 cases of CD were identified, yielding a prevalence of 0.018% in the general population and 2.7% among the 2,000 clinic attendees. The mean age was [corrected value] years (SD = 3.24), and 64.8% were female. Growth disturbances were the most common manifestation (59.2%), followed by diabetes-related symptoms (29.6%). Gastrointestinal symptoms were present in only 14.8%. Mean anti-tTG IgA titer was 198.37 IU/dL, and higher titers correlated with more advanced Marsh grades (Marsh 3C: 281.52 IU/dL).

Conclusion: The prevalence of CD in Sabzevar is lower than global averages, suggesting significant under diagnosis. Growth disturbances and association with type 1 diabetes are prominent. Increased physician awareness, particularly of extra intestinal manifestations, is essential for early diagnosis and prevention of complications.

Keywords: Celiac disease, Marsh classification, anti-tissue transglutaminase, prevalence, Iran