Increased Prevalence and Mortality in Undiagnosed Celiac Disease

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Gastroenterology (Impact Factor: 16.72). 04/2009; 137(1):88-93. DOI: 10.1053/j.gastro.2009.03.059
Source: PubMed


The historical prevalence and long-term outcome of undiagnosed celiac disease (CD) are unknown. We investigated the long-term outcome of undiagnosed CD and whether the prevalence of undiagnosed CD has changed during the past 50 years.
This study included 9133 healthy young adults at Warren Air Force Base (sera were collected between 1948 and 1954) and 12,768 gender-matched subjects from 2 recent cohorts from Olmsted County, Minnesota, with either similar years of birth (n = 5558) or age at sampling (n = 7210) to that of the Air Force cohort. Sera were tested for tissue transglutaminase and, if abnormal, for endomysial antibodies. Survival was measured during a follow-up period of 45 years in the Air Force cohort. The prevalence of undiagnosed CD between the Air Force cohort and recent cohorts was compared.
Of 9133 persons from the Air Force cohort, 14 (0.2%) had undiagnosed CD. In this cohort, during 45 years of follow-up, all-cause mortality was greater in persons with undiagnosed CD than among those who were seronegative (hazard ratio = 3.9; 95% confidence interval, 2.0-7.5; P < .001). Undiagnosed CD was found in 68 (0.9%) persons with similar age at sampling and 46 (0.8%) persons with similar years of birth. The rate of undiagnosed CD was 4.5-fold and 4-fold greater in the recent cohorts, respectively, than in the Air Force cohort (both P < or = .0001).
During 45 years of follow-up, undiagnosed CD was associated with a nearly 4-fold increased risk of death. The prevalence of undiagnosed CD seems to have increased dramatically in the United States during the past 50 years.

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    • "Gluten is a mixture of gliadins and glutenins that differ in their electrophoretic mobility (Payne et al., 1985; Jacobsen et al., 2007). Gluten is also the main allergen in the wheat grain and is responsible for nutritive intolerances such as celiac disease or gluten-sensitive enteropathy (Rubio-Tapia et al., 2009), and various allergies (Battais et al., 2008; Sapone et al., 2012; Mauro Martin et al., 2014). In addition to storage proteins, wheat grain allergens include enzymatic and structural proteins such as prolamins, cupins, and Bet v1 protein family (Breiteneder and Mills, 2005). "
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    ABSTRACT: The aim of the work was to test relatively simple proteomics approach based on phenol extraction, two-dimensional electrophoresis (2-DE) in combination with 7cm immobilized pH gradient strips for the determination of clinically relevant proteins in wheat grain. Using this approach, 157 2-DE spots were quantified in biological triplicate, out of which 53 were identified by MALDI-TOF/TOF mass spectrometry. Clinically relevant proteins associated with celiac disease, wheat dependent exercise induced anaphylaxis, baker´s asthma, and food allergy, were detected in 24 2-DE spots. The comparison with recent quantitative study suggested that gel-based and gel-free proteomics approaches are complementary for the detection and quantification of clinically relevant proteins in wheat grain.
    Frontiers in Plant Science 06/2015; 6. DOI:10.3389/fpls.2015.00433 · 3.95 Impact Factor
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    • "In CD, genetically predisposed individuals develop small-intestinal villous atrophy in response to dietary gluten intake [3]. In the last decades the prevalence of CD has more than doubled, [4] suggesting that environmental factors other than gluten-exposure may have a significant influence on CD development [5]. Earlier research has in particular emphasized the importance of environmental factors early in life, including pregnancy and the perinatal period, [6,7] for the development of CD. "
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    ABSTRACT: The infant microbiota may play a pathogenic role in coeliac disease (CD). Antibiotic treatment in pregnancy is common and could significantly impact the infant microbiota. In this study, we aimed to investigate the association between antibiotic exposure during pregnancy and CD in offspring. Prospective questionnaire data on antibiotic exposure in pregnancy were available in 8729 children participating in the All Babies in Southeast Sweden (ABIS) cohort study, and of these 46 developed CD until December 2006. Cox regression estimated hazard ratios (HRs) for CD in the offspring among mothers exposed to antibiotics during pregnancy, with adjustment for parent-reported diary data on breastfeeding, age at gluten introduction and number of infections in the child's first year of life. Of the 1836 children exposed to antibiotics during pregnancy, 12 (0.7%) children developed CD as compared with 34/6893 (0.5%) unexposed children (HR = 1.33; 95%CI = 0.69-2.56). Risk estimates remained unchanged after adjustment for breastfeeding, age at gluten introduction and infection load in the child's first year of life (HR = 1.28; 95%CI = 0.66-2.48). We found no statistically significant association between antibiotic exposure during pregnancy and CD in offspring. This lack of association may either be true or the result of limited statistical power.
    BMC Gastroenterology 04/2014; 14(1):75. DOI:10.1186/1471-230X-14-75 · 2.37 Impact Factor
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    • "The increasing prevalence of CD, especially in adults, its atypical clinical presentation, and also the lifelong adherence to a gluten-free diet (GFD) as the only option for healthy state create an imperative need for proper immunological tests that can easily, timely, and effectively diagnose CD and monitor GFD [12] [13] [14] [15] [16] "
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    ABSTRACT: The increasing prevalence of celiac disease (CD), especially in adults, its atypical clinical presentation, and the strict, lifelong adherence to gluten-free diet (GFD) as the only option for healthy state create an imperative need for noninvasive methods that can effectively diagnose CD and monitor GFD. Aim. Evaluation of anti-endomysium (EmA) and anti-tissue transglutaminase IgA (tTG-A) antibodies in CD diagnosis, GFD monitoring, and first degree relatives screening in CD adult patients. Methods. 70 newly diagnosed Greek adult patients, 70 controls, and 47 first degree relatives were tested for the presence of EmA and tTG-A. The CD patients were monitored during a 3-year period. Results. EmA predictive ability for CD diagnosis was slightly better compared to tTG-A (P = 0.043). EmA could assess compliance with GFD already from the beginning of the diet, while both EmA and tTG-A had an equal ability to discriminate between strictly and partially compliant patients after the first semester and so on. Screening of first degree relatives resulted in the identification of 2 undiagnosed CD cases. Conclusions. Both EmA and tTG-A are suitable markers in the CD diagnosis, in the screening of CD among first degree relatives, having also an equal performance in the long term monitoring.
    04/2014; 2014:623514. DOI:10.1155/2014/623514
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