In the Journals

Scotland celiac disease incidence increased in past 20 years

There has been a six times increase in the incidence of celiac disease in Scotland during the past 20 years, according to recent study findings published in Pediatrics.

“The significant increase in classic cases is strongly suggestive of a true rise in [celiac disease] incidence. Use of the strictest definition of classic pediatric [celiac disease] does not abolish this significant rise,” the researchers wrote.

The retrospective cohort study included 266 children diagnosed with celiac disease in southeast Scotland from 1990 to 2009.

Researchers found an increase in incidence rates from 1.8 per 100,000 (95% CI, 1.1-2.7) to 11.7 per 100,000 (95% CI, 9.8-13.9) from 1990 to 1994 and from 2005 to 2009, respectively. Rates for non-classic presentation increased by 1,566% from 1990 to 1999 and 1,170% from 2000 to 2009. There was also an increase in Oslo classic cases from 1.51 per 100,000 (95% CI, 0.91-2.38) from 1990 to 1994 to 5.22 per 100,000 (95% CI, 3.98-6.75) from 2005 to 2009.

“Although this study demonstrates an increase that may not be completely answered by increased awareness, it’s an important diagnosis to consider in a multitude of presentations including childhood abdominal pain and in constipation,” Peter M. Gillett, MBChB, FRCP, FRCPH, of the Royal Hospital for Sick Children told Infectious Diseases in Children.

“This paper confirms suspician from other areas of the United Kingdom that we are all seeing increasing numbers - many of those are from screened populations such as Type I diabetes and Down syndrome as well as family member of affected patients. The issue of screening “at-risk” patients is an important one and proper counseling of families and patients as to the implications of a positive test are vital - ultimately it’s the family who should make that decision. The challenge, long term, is to tease out the factors that influence presentation and whether patients who are symptom free (but who are coeliac) have different long term risks to those who present with barn-door symptoms.

Disclosure: The study was funded in part by the GI-Nutrition Research Fund, Child Life and Health, University of Edinburgh, Coeliac UK and the Gloag Family Foundation. One researcher reports support from an NHS Research Scotland career fellowship award.

Peter M. Gillett, MBChB, FRCP, FRCPH, can be reached at peter.gillett@luht.scot.nhs.uk.

There has been a six times increase in the incidence of celiac disease in Scotland during the past 20 years, according to recent study findings published in Pediatrics.

“The significant increase in classic cases is strongly suggestive of a true rise in [celiac disease] incidence. Use of the strictest definition of classic pediatric [celiac disease] does not abolish this significant rise,” the researchers wrote.

The retrospective cohort study included 266 children diagnosed with celiac disease in southeast Scotland from 1990 to 2009.

Researchers found an increase in incidence rates from 1.8 per 100,000 (95% CI, 1.1-2.7) to 11.7 per 100,000 (95% CI, 9.8-13.9) from 1990 to 1994 and from 2005 to 2009, respectively. Rates for non-classic presentation increased by 1,566% from 1990 to 1999 and 1,170% from 2000 to 2009. There was also an increase in Oslo classic cases from 1.51 per 100,000 (95% CI, 0.91-2.38) from 1990 to 1994 to 5.22 per 100,000 (95% CI, 3.98-6.75) from 2005 to 2009.

“Although this study demonstrates an increase that may not be completely answered by increased awareness, it’s an important diagnosis to consider in a multitude of presentations including childhood abdominal pain and in constipation,” Peter M. Gillett, MBChB, FRCP, FRCPH, of the Royal Hospital for Sick Children told Infectious Diseases in Children.

“This paper confirms suspician from other areas of the United Kingdom that we are all seeing increasing numbers - many of those are from screened populations such as Type I diabetes and Down syndrome as well as family member of affected patients. The issue of screening “at-risk” patients is an important one and proper counseling of families and patients as to the implications of a positive test are vital - ultimately it’s the family who should make that decision. The challenge, long term, is to tease out the factors that influence presentation and whether patients who are symptom free (but who are coeliac) have different long term risks to those who present with barn-door symptoms.

Disclosure: The study was funded in part by the GI-Nutrition Research Fund, Child Life and Health, University of Edinburgh, Coeliac UK and the Gloag Family Foundation. One researcher reports support from an NHS Research Scotland career fellowship award.

Peter M. Gillett, MBChB, FRCP, FRCPH, can be reached at peter.gillett@luht.scot.nhs.uk.