Celiac Disease : A Scientometric Analysis of World Publication Output , 2005-2014

International license. Cite this article: Bansal M, Gupta R, Bansal J. Celiac Disease: A Scientometric Analysis of World Publication Output, 2005-2014. OGH Reports. 2017;6(1):8-15. ABSTRACT The paper presents an analysis of 14317 world papers in celiac disease, retrieved from Scopus database for the period 2005-14, experiencing an annual average growth rate of 5.20% and citation impact of 12.53.The 15 most productive countries account for 83.89% share in world output, with largest share (21.40%) coming from U.S.A, followed by Italy (12.61%), U.K. (8.23%), Germany (5.41%) etc., during 2005-14. U.S.A achieved the global citation share (35.13%) followed by Italy (17.16%), U.K. (15.74%) etc. Medicine registered the highest publication share (87.93%), followed by biochemistry, genetics and molecular biology (13.56%), immunology and microbiology (6.73%), agricultural and biological sciences, (5.57%), nursing (3.07%), pharmacology, toxicology and pharmaceutics (2.74%), neurosciences (2.26%), etc. Diarrhoea contributed the largest share (8.10%) in publications by symptoms during 2005-14, followed by abdominal pain (7.68%), insulin dependent diabetes mellitus (6.84%), Crohn disease (6.22%), enteritis (5.34%), etc. Gluten free diet contributed the largest share (18.47%) among significant keywords. The 15 most productive organisations, authors and journals accounted for 15.06%, 10.71% and 16.57% share of the world publication output respectively during 2005-14. It is concluded that individual countries must foster global research and development, by way of providing increased investment in R and D and increase their specialized manpower and provide adequate training courses and infrastructural facilities to scientists and researchers to control the challenges faced by the spread of this disease.


INTRODUCTION
Celiac disease-also known as celiac sprue or glutensensitive enteropathy-is a digestive and autoimmune disorder that results in damage to the lining of the small intestine when foods with gluten are eaten.Gluten is a form of protein found in some grains.The damage to the intestine makes it hard for the body to absorb nutrients, especially fat, calcium, iron, and folate.Normally, the body's immune system is designed to protect it from foreign invaders.When people with celiac disease eat foods containing gluten, their immune system forms antibodies to gluten which then attack the intestinal lining.This causes inflammation in the intestines and damages the villi, the hair-like structures on the lining of the small intestine.Nutrients from food are normally absorbed by the villi.If the villi are damaged, the person cannot absorb nutrients properly and ends up malnourished, no matter how much he or she eats. [1]eliac disease cannot be "caught, " but rather the potential for celiac disease is in the body from birth.Its onset is not confined to a particular age range or gender, although more women are diagnosed than men.It is not known exactly what activates the disease, however three things are required for a person to develop celiac disease: (i) A genetic dis-position: being born with the necessary genes.The Human Leukocyte Antigen (HLA) genes specifically linked to celiac disease are DR3, DQ2 and DQ8...and others; (ii) An external trigger: some environmental, emotional or physical event in one's life.While triggering factors are not fully understood, possibilities include, but are not limited to adding solids to a baby's diet, going through puberty, enduring a surgery or pregnancy, experiencing a stressful situation, catching a virus, increasing WBRO products in the diet, or developing a bacterial infection to which the immune system responds inappropriately, (iii) A diet: containing gluten and related polyamines, (iv) Auto-antigen enzyme, tissue transglutaminase (TG2) also TG4 and TG6 and (v) Production of pro-inflammatory cytokines, especially interferon (IFN-γ). [2]he signs and symptoms of celiac disease include: (1)  Gastrointestinal Symptoms -(i) Diarrhea in 45-85% of patients, (ii) Flatulence in 28% of patients, (iii) Borborygmus in 35-72% of patients, (iv) Weight loss in 45% of patients; in infants and young children with untreated celiac disease, failure to thrive and growth retardation are common, (v) Weakness and fatigue in 78-80% of patients; usually related to general poor nutrition and (vi) severe abdominal pain in Madhu Bansal 1 , Ritu Gupta 2 and Jivesh Bansal 3*

Celiac Disease: A Scientometric Analysis of World Publication Output, 2005-2014
34-64% of patients and (ii) Extraintestinal Symptoms -(I) Anemia in 10-15% of patients, (II) Osteopenia and osteoporosis in 1-34% of patients, (III) Neurologic symptoms in 8-14% of patients; include motor weakness, paresthesias with sensory loss, and ataxia; seizures may develop, (III) Skin disorders in 10-20% of patients; including dermatitis herpetiformis, a condition with pruritic, papulovesicular skin lesions involving the extensor surfaces of the extremities, trunk, buttocks, scalp, and neck, (iv) Hormonal disorders -Including amenorrhea, delayed menarche, and infertility in women and impotence and infertility in men and (v) A bleeding diathesis is usually caused by prothrombin deficiency, due to impaired absorption of fat-soluble vitamin K. [3] Approximately 3 million people in Europe and another 3 million people in the United States are estimated to be affected by celiac disease.Celiac disease is prevalent in European countries with temperate climates.The highest prevalence of celiac disease is in Ireland and Finland and in places to which Europeans emigrated, notably North America and Australia.In these populations, celiac disease affects approximately 1 in 100 individuals.The incidence of celiac disease is increasing among certain populations in Africa (Saharawui population), Asia (India), and the Middle East.Celiac disease is most prevalent in Western Europe and the United States, with an increasing incidence in Africa and Asia.Females are affected slightly more than males.The age distribution of patients with celiac disease is bimodal, the first at 8-12 months and the second in the third to fourth decades.The mean age at diagnosis is 8.4 years (range, 1-17 y).Celiac disease might become apparent in infants when gluten ingestion begins.Symptoms of celiac disease might persist throughout childhood if untreated but usually diminish in adolescence.Symptoms often reappear in early adulthood, between the third and fourth decades of life.Approximately 20% of patients with celiac disease are older than 60 years. [Adolescents with celiac disease frequently present with extra intestinal manifestations, including short stature, behavioral problems, fatigue, and skin problems.The diagnosis of celiac disease is often not established until middle age or old age. [4]

Literature Review
Only few quantitative studies are carried output on celiac disease publications.Among such studies, Master.Lebwohl, Ludvigsson and Green [5] demonstrated that the quality and complexity of celiac disease research in both Journal of Pediatric Gastroenterology and Nutrition and Am Journal of Gastroenterology is comparable based on the similarities between the study topic and scope, funding, study design, and statistical methods.Good clinical research practices can be seen for celiac disease research on both the pediatric and adult levels.Narolsky, Green and Lebwohl [6] analysed the temporal and geographic trends in celiac disease publications for the period 1960-2009.The authors analyzed CD publication output with respect to its degree of diffusion among journals and authors, and assessed for an association between economic parameters and output.A similar bibliometric study on global output (13536 papers) on celiac disease was conducted by Bhardwaj [7] for the period 2001-12, with focus on publication growth, population age-group, country-wise and subject-wise scatter of publications and productivity of leading organizations, authors and journals.The present studies cover much larger dimensions than earlier studies.

OBJECTIVES
The main objective of this study is to analyse the global research output in celiac disease during 2005-14 with specific focus on (i) World Research output, its growth, rank and share of leading countries, (ii) the share of international collaboration papers, (iii) output and impact by different types of research, symptoms treatment methods and by different age groups (iv) publications productivity and citation impact of 15 leading institutions and authors; and (v) media of communication of the global research output in the most productive journals.

MATERIALS AND METHODS
This study used the Scopus international database to extract relevant publications in celiac disease research of the world and 15 most productive countries, for a period of 10 years (2005-14).A well defined search strategy involving 'Celiac' as the key-word in "TITLE-ABS-KEY" tag was used to search and download data resulting in 14317 global publications in celiac disease.The main search strategy was limited to affiliation tag and period tag to get the output in India and other countries.Papers were analysed by subfields by using classification as provided in Scopus database.Celiac disease research output was classified according to population age groups, symptoms, important keywords using different search strategies.Different tags under search strategy were used to analyse significant institutions, authors and journals.

ANALYSIS
The world publication output on celiac disease during 2005-2014 consisted of 14317 papers, which steadily increased from 1097 papers in 2005 to 1729 papers in 2014, witnessing an annual average growth rate of 5.20%.The world cumulative publication output has increased from 6209 papers during 2005-09 to 8108 papers during 2010-14, registering a growth rate of 30.58%.In terms of impact and citation quality, the average citation registered by world publication was 12.53 during 2005-14 which decreased from 18.71 during 2005-09 to 7.81 during 2010-14.(Table 1) The articles constituted 65.48% share (9375) of the total world publications on celiac disease during 2005-14, followed by reviews (16.11%, 2307 papers), letters (6.70%, 960 papers), conference papers (2.25%, 323 papers), book chapter (1.70%, 244), and others appearing as articles in short survey, article in press, erratum, book conference review etc.The 85.45% (12238 papers) of the world publications in celiac disease appeared in English followed by Spanish (2.86%, 410 papers), German (2.14%, 307 papers), French (1.98%, 284 papers), Chinese (1.84%, 263 papers) and in 29 other languages.

Celiac disease publication output in context of different subjects
The global publication output in celiac disease research has been published in context of different subject as retrieved from Scopus database.The highest publication share came from Medicine (12589 papers, 87.93%), followed by biochemistry, genetics and molecular biology (1942 papers, 13.56%), immunology and microbiology (964 papers, 6.73%), agricultural and biological sciences (797 papers, 5.57%), nursing (440 papers, 3.07%), pharmacology, toxicology and pharmaceutics (393 papers, 2.74%), neurosciences (324 publications, 2.26%) and other subjects have share of less than 2 percent.The publication activity, as reflected in activity index, increased in medicine, biochemistry, genetics and molecular biology, immunology and microbiology, agricultural and biological sciences, nursing, chemistry and engineering, as against decrease in pharmacology, toxicology and pharmaceutics, neurosciences and health profession from 2005-09 to 2010-14.Immunology and microbiology has scored the highest citation impact per paper of 22.40, followed by nursing (17.76), biochemistry, genetics and molecular biology (15.63), neuroscience (15.13), agricultural and biological sciences (14.40), pharmacology, toxicology and pharmaceutics (14.00), chemistry (13.52), medicine (12.03), health professions (11.84) and engineering (6.48) during 2005-14 (Table 4).World celiac disease research output by type of population group In the classification of global celiac disease research by population by age-group, the greatest focus was on adults (with 36.29%share), followed by the middle-aged (22.74% share), adolescent (16.64% share), children (17.75% share), aged above 80 years (6.58% share).The publication share has increased in adolescents (from 16.62% to 16.66%), children (from 16.39% to 18.83%) and aged above 80 (from 6.37% to 6.75%), as against decrease in adults (from 37.68% to 35.22%0 and middle aged (from 22.94% to 22.54%) from 2005-09 to 2010-14 (Table 5).

Research profile of the highly productive institutions in celiac disease research
The top 15 most productive institutions involved in celiac disease research individually published 112 to 219 papers and together published 2157 papers, accounting for 15.06% share of world publications during 2005-14.The scientometric profile of these 15 organizations along with their research output, citations received, and h-index values are presented in Table 8.Six institutions have registered a higher publication share than the group average productivity of 143.8 articles per institution: The University of Naples Federico II , Naples, Italy with 219 papers followed by Mayo Clinic, Rochester, USA (206 papers), V.U University Medical Centre, Netherlands (174 papers), University Hospital of Tampere, Finland (174 papers), Università degli Studi di Roma "La Sapienza", Rome, Italy , (154 papers) and The Örebro County Council, Sweden (147 papers) during 2005-14.The average citation per paper of top 15 organizations varied from 17.00 to 39.80, with an average of 25.84 during 2005-14.Eight organizations have registered a higher citation impact than the group average citation impact: Leiden University Medical Centre, Leiden, Netherlands (39.80),VU University Medical Centre, Netherlands (31.13),Royal Hallamshere Hospital, South Yorkshere, U.K. (30.60),University of Milan, Italy (28.44),Harvard Medical School (27.77),Karolinska University Hospital (26.93),University of Tampere, Finland (26.23) and The University of Naples Federico II, Naples, Italy (26.01).The average h-index value of these 15 highly productive organizations was 31 and five organizations have scored a higher h-index value that the groups average h-index: Mayo clinic, Rochester, USA (41), The University of Naples Federico II, Italy (39), V.U University Medical Centre, Leiden, Netherlands (36), Leiden University Medical Centre, Leiden, Netherlands (36) and University Hospital of Tampere, Finland (35) (Table 8).

Contribution and impact of highly productive authors in celiac disease research
The top 15 most productive authors involved in celiac disease research individually published 58 to 155 papers and together published 1533 papers, accounting for 10.71% share of world publications during 2005-14.The scientometric profile of these 15 authors along with their research output, citations received, and h-index values are presented in Table 9  mentary Pharmacology and Therapeutics (179 papers), etc during 2005-14 (Table 10).

SUMMARY AND CONCLUSIONS
The world has contributed 14317 papers in celiac disease, during 2005-2014 which increased from 1097 papers in 2005 to 1729 papers in 2014, witnessing an annual average growth rate of 5.20%.The average citation impact per paper registered by global publications in celiac

Table 3 : Number and share of international collaborative papers of top 15 most productive countries in celiac disease, 2005-14
OGH Reports, Vol 6, Issue 1, Jan-Jun, 2017