The under-diagnosis can be explained by the celiac iceberg model Figure 1 which is related to the frequency of predisposing haplotypes in each population and of gluten consumption habits. The tip of the iceberg is the symptomatic patients, but the submerged part of the iceberg contains the majority of the cases who have not been diagnosed. They may have atypical symptoms or may not even have symptoms. For every case diagnosed, it is estimated that there are 5 to 10 undiagnosed cases 11. Figure 1. Iceberg model of Celiac Disease. Modified from de: Fasano A. Celiac disease in children.
El subdiagnóstico puede explicarse basados en el modelo del iceberg celíaco figura 1, relacionado con la frecuencia de haplotipos predisponentes en cada población y de los hábitos de consumo de gluten de esta, donde la punta del iceberg serían los pacientes sintomáticos, pero la parte sumergida del iceberg, donde están la mayoría de los pacientes, representa lo casos no diagnosticados, por manifestar síntomas atípicos o incluso no tenerlos 5-10 pacientes por cada caso diagnosticado 11.