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Increased Prevalence and Mortality in Undiagnosed Celiac Disease – Source: Gastroenterology, July 2009

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Background & Aims: 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.

Methods: This study included 9,133 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 = 5,558) or age at sampling (n = 7,210) 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.

Results:
Of 9,133 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 [recent] 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 ? .0001).

Conclusions:

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.

Source: Gastroenterology, July 2009;137(1)pp 373-374. PMID 19362553 by Rubio-Tapia A, Murray JA, et al. Divisions of Gastroenterology and Hepatology, Hematology, Biomedical Informatics and Statistics, and Epidemiology, Mayo Clinic, Rochester, Minnesota; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA. [E-mail: murray.joseph@mayo.edu]

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