Article

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

ABSTRACT

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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    • "The incidence of both diagnosed (Catassi et al, 2010) and undiagnosed coeliac disease (Rubio-Tapia et al, 2009) is rising (Lohi et al, 2007; Ludvigsson et al, 2013), particularly when gluten sensitivity symptoms are included (Sapone et al, 2012) across a gluten sensitivity spectrum (Cornwell et al, 2005). These incidents are occurring despite US wheat flour-based product domestic consumption falling from above 100kg per capita in 1900 to 50kg in 1970, then increased to 66kg in 2000, but fell to 60kg in 2008 (Kasarda, 2013). "
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    • "Although the prevalence of CD has been increasing over the last 50 years—nearly fourfold in the United States (US)— population based studies suggest that only a small proportion of CD cases are clinically recognized (Mustalahti 2010, Rubio-Tapia 2009). The difficulty in accurately detecting CD arises from its heterogenous clinical picture, with symptoms ranging from Bclassic^ gastrointestinal malabsorption (with diarrhea at the time of diagnosis seen in only 50 % of patients) to only atypical presentations (Barker 2008). "
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