Morbidity and Mortality Among Older Individuals With Undiagnosed Celiac Disease

Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Gastroenterology (Impact Factor: 16.72). 09/2010; 139(3):763-9. DOI: 10.1053/j.gastro.2010.05.041
Source: PubMed


Outcomes of undiagnosed celiac disease (CD) are unclear. We evaluated the morbidity and mortality of undiagnosed CD in a population-based sample of individuals 50 years of age and older.
Stored sera from a population-based sample of 16,886 Olmsted County, Minnesota, residents 50 years of age and older were tested for CD based on analysis of tissue transglutaminase and endomysial antibodies. A nested case-control study compared serologically defined subjects with CD with age- and sex-matched, seronegative controls. Medical records were reviewed for comorbid conditions.
We identified 129 (0.8%) subjects with undiagnosed CD in a cohort of 16,847 older adults. A total of 127 undiagnosed cases (49% men; median age, 63.0 y) and 254 matched controls were included in a systematic evaluation for more than 100 potentially coexisting conditions. Subjects with undiagnosed CD had increased rates of osteoporosis and hypothyroidism, as well as lower body mass index and levels of cholesterol and ferritin. Overall survival was not associated with CD status. During a median follow-up period of 10.3 years after serum samples were collected, 20 cases but no controls were diagnosed with CD (15.2% Kaplan-Meier estimate at 10 years).
With the exception of reduced bone health, older adults with undiagnosed CD had limited comorbidity and no increase in mortality compared with controls. Some subjects were diagnosed with CD within a decade of serum collection, indicating that although most cases of undiagnosed CD are clinically silent, some result in symptoms. Undiagnosed CD can confer benefits and liabilities to older individuals.

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    • "Our finding that CD is not associated with the risk of colon carcinoma is congruent with the results of different analyses of cancer risk in CD. According to these analyses, the risk of some site-specific malignancies in general is elevated in CD, but CD does not have a strong correlation with the overall cancer risk and mortality for neoplasms [3] [7] [14]. Different causes might account for the overall low risk of colon cancer in CD: the very low gluten load that reaches the large intestine, the different histology of the colon mucosa with respect to the duodenum, the reduced absorption of fats and carcinogens through the inflamed intestinal mucosa [15]. "
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    ABSTRACT: Objective: Celiac disease (CD) has strongly been established as associated with some site-specific gastrointestinal malignancies. On the contrary, according to the few reports available, the risk of colon carcinoma in CD patients has been described similar to that of general population. In this cohort study, we describe the risk of colon carcinoma in a group of Italian celiac patients. Materials and methods: The study population included all CD patients diagnosed at the Collaborating Centers of the Italian Registry of CD between 1st January 1982 and 31st December 2006. Upon diagnosis of CD and upon at every subsequent clinical control, the Collaborating Centers filled in a validated form for each CD patient reporting information about demographic data, possible occurrence of a neoplasm and adherence to a gluten-free diet. Results: Out of 1757 celiac patients enrolled, 6 developed a colon carcinoma during the follow-up period (mean: 18.1 years). The standardized incidence ratio (SIR) resulted 0.29 (95% CI=0.07-0.45). Stratifying the risk for the dietary gluten intake, the SIR dropped to 0.07 (95% CI=0.009-0.27) for CD patients with a strict adherence to a gluten-free diet. Conclusion: We confirm the previous finding that there is low risk to develop a colon cancer in celiac patients.
    Full-text · Article · May 2014 · Scandinavian Journal of Gastroenterology
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    • "CD can present in a variety of different ways such as anemia or short stature without gastrointestinal involvement and may be missed by physicians. Lack of diagnosis and non-adherence to treatment may have a number of adverse health outcomes such as osteoporosis, increased occurrence of autoimmune diseases, decreased quality adjusted life years and increased standardized mortality ratio [7-10]. Furthermore, in poorer countries, children with CD may commonly present with chronic diarrhea and malnutrition, correct diagnosis is often overlooked, and may result in unnecessary mortality [11]. "
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    ABSTRACT: The aim of this study was to identify costs in patients diagnosed with Celiac disease. This retrospective case control study covered the period 2003-2006 and was conducted in a large Israeli Health Maintenance Organization insuring over two million members. Our cohort comprised 1,754 patients with Celiac disease with a control group of 15,040. Costs were aggregated according to main cost-branches and computed individually for each member. A linear step wise regression was performed with costs being the dependent variable and the independent variables; age, gender and the presence of celiac disease. Costs were compared with patients suffering from other chronic diseases. The total costs of the patients with celiac disease were significantly higher than that of the control group for hospital admission, medications, laboratory and imaging. Hospital admission rate was 7.98% as opposed to 7.1% for the control group (p = 0.06). When compared with other chronic illnesses, the costs of patients with celiac disease were similar to those of patients with diabetes and hypertension. Patients with Celiac disease utilize medical services more than the general population. This research suggests that the use of medical resources by patients with Celiac disease may be higher than previously thought.
    Full-text · Article · Nov 2013
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    • "These findings were not statistically significant although there was limited statistical power given the low number of individuals reporting a gluten-free diet. To the degree that self-report gluten-free diet data can be used to approximate non-celiac gluten sensitivity prevalence, the current results suggest the prevalence to be almost half the prevalence of celiac disease [3] [4] [5]. This finding is noteworthy, as current clinical inference has suggested that non-celiac gluten sensitivity is far more common than celiac disease [24] [25]. "
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    ABSTRACT: Objectives: Clinical inference suggests the prevalence of non-celiac gluten sensitivity is substantially higher than that of celiac disease in the USA. Unfortunately, there are currently no data supporting these claims. The authors analyzed nationally representative data to estimate the prevalence of adherence to a gluten-free diet among participants without celiac disease and also to characterize the demographics and general health status of these participants. Study design and setting: The Continuous National Health and Nutrition Examination Survey (NHANES) 2009-2010 enrolled 7762 individuals representing the civilian, non-institutionalized, US population free of celiac disease. Participants responded to interviewer administered questionnaires regarding current adherence to a gluten-free diet. Prevalence estimates were computed using SAS survey procedures. Results: There were 49 individuals who reported current adherence to a gluten-free diet reflecting a weighted prevalence of 0.548% (95% CI 0.206-0.889). The prevalence of a gluten-free diet was higher in females (0.58%) than males (0.37%), although this was not statistically significant (p = 0.34). Participants reporting a gluten-free diet were older (46.6 vs. 40.5 years, p = 0.005), had higher high-density lipoprotein, lower iron and lower body mass index. Conclusions: The estimated national prevalence of non-celiac gluten sensitivity is 0.548%, approximately half that of celiac disease. Future studies are merited in order to better understand the population burden of non-celiac gluten sensitivity.
    Full-text · Article · Jul 2013 · Scandinavian Journal of Gastroenterology
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