Prevalence Of Coeliac Disease In Adults Research Articles

Coeliac disease and hypertransaminasaemia: a systematic review and meta-analysis

<h3>Introduction</h3> Several studies have suggested a positive association between coeliac disease (CD) and hypertransaminasaemia, but no single study has systematically synthesised all available evidence examining this issue. We conducted a systematic review and meta-analysis to determine the prevalence of CD in adults presenting with cryptogenic hypertransaminasaemia, as well as the prevalence of hypertransaminasaemia in patients with newly-diagnosed CD. <h3>Methods</h3> MEDLINE and EMBASE were searched (up to September 2010) to identify case series and case-control studies (sample size &gt;90) that applied serological tests and/or distal duodenal biopsy to unselected adult patients (&gt;90% aged 16 years or over) with cryptogenic hypertransaminasaemia. The proportion of individuals with abnormal serum transaminases who had either positive coeliac serology, or biopsy-proven CD, were combined to give a pooled prevalence, with 95% confidence intervals (CI). Studies of patients with newly-diagnosed biopsy-proven CD that applied tests of liver function were also eligible. The pooled prevalence of hypertransaminasaemia among newly-diagnosed CD patients was calculated with 95% CIs. <h3>Results</h3> The search identified 2705 citations. Of these, 31 appeared relevant and were retrieved for evaluation. Twelve studies were eligible for inclusion, with excellent agreement between investigators (Kappa = 0.86). Six studies, involving 919 patients, reported the prevalence of positive coeliac serology or biopsy-proven CD in patients with cryptogenic hypertransaminasaemia, with a pooled prevalence of 5.9% (95% CI 2.7% to 10.3%). Five studies excluded other causes of abnormal serum transaminases prior to screening for CD. When only these five studies were analysed, the pooled prevalence increased to 6.4% (95% CI 2.6% to 11.7%). The pooled prevalence of biopsy-proven CD in cryptogenic hypertransaminasaemia in the 6 studies was 3.6% (95% CI 1.4% to 7.0%) and 4.1% (95% CI 1.4% to 8.2%) in the five studies that first excluded other causes of abnormal transaminases. A further six studies, involving 1830 patients, reported the frequency of abnormal serum transaminases in newly-diagnosed CD, with a pooled prevalence of 22% (95% CI 8% to 39%). <h3>Conclusion</h3> More than 20% of individuals with newly-diagnosed CD may have abnormal serum transaminases. The prevalence of CD in individuals with hypertransaminasaemia is between 3% and 4%, suggesting that routine screening for CD in this group of patients may be worthwhile. However, yield may be lower in individuals in whom other potential causes of hypertransaminasaemia have not already been excluded.

Incidence and prevalence of diagnosed coeliac disease in Finland: Results of effective case finding in adults

Objective. The majority of patients with coeliac disease remain undetected world-wide. Finland has aimed at a high detection rate by training health personnel, and has advocated serologic screening for known coeliac disease risk groups. The purpose here was to assess whether this approach has been effective in clinical practice. Material and methods. The study was based on a prospective database of new coeliac patients aged 16 years or more, to whom the Social Insurance Institution had paid monthly compensation for the additional cost of maintaining a gluten-free diet since 2002. To obtain this compensation the diagnostic criteria for coeliac disease, including biopsy findings, had to be attested in a statement from a physician. The incidence and prevalence rates were calculated until the end of 2006. The total population aged 16 years or more was 4.31 million. Results. In 2004–06, a total of 5020 persons (64% female) receiving a new dietary grant were identified through the database. The mean annual incidence of proven coeliac disease was thus 39 per 100,000 individuals. Altogether, 23,553 persons received the dietary grant. This gives a nation-wide point prevalence of adult coeliac disease of 0.55% (0.70% F, 0.38% M). There was a regional variation from 33 to 49 per 100,000 in the annual incidence and from 0.41% to 0.72% in the prevalence of coeliac disease. Conclusions. To the best of our knowledge, these figures for proven coeliac disease are the highest reported. Increased alertness to the condition and active case finding has made this efficient diagnostics possible.

Coeliac disease in The Netherlands

Background: The prevalence of adult coeliac disease in The Netherlands was studied in the Dutch Coeliac Disease Society and in blood donors but not in the general population. We therefore studied the prevalence of recognized and unrecognized coeliac disease in a large cohort, representative of the adult Dutch general population. Blood samples were available for anonymous research, as well as data on dietary habits, self‐reported physical characteristics, health problems, quality of life and socio‐economic circumstances. Methods: Subjects included 50,760 individuals who had previously participated in two large population‐based studies on health status in relation to lifestyle factors. Recognized coeliac disease was studied in all subjects by identification of self‐reported adherence to a gluten‐free diet and subsequent confirmation of the diagnosis of coeliac disease. Unrecognized coeliac disease was studied in a random sample of 1440 out of the 50,760 subjects through serologic screening and human lymphocyte antigen (HLA) typing. Results: The prevalence of recognized coeliac disease was 0.016% (95% confidence interval 0.008–0.031) and of unrecognized coeliac disease 0.35% (95% confidence interval 0.15–0.81). Menarcheal age was higher in women with recognized coeliac disease than in women without coeliac disease. Conclusions: The prevalence of adult recognized coeliac disease in The Netherlands is one of the lowest in Europe, while the prevalence of unrecognized coeliac disease is comparable with that in other European countries. Adult coeliac disease is strongly under diagnosed in The Netherlands. The higher menarcheal age in women with recognized coeliac disease may be explained by diagnostic delay.

High Incidence and Prevalence of Adult Coeliac Disease Augmented Diagnostic Approach

Collin P, Reunala T, Rasmussen M, Kyrönpalo S, Pehkonen E, Laippala P, Mäki M. High incidence and prevalence of adult coeliac disease. Augmented diagnostic approach. Scand J Gastroenterol 1997; 32: 1129–1133.Background: The diagnosis of coeliac disease is easily overlooked as patients can present with mild or atypical symptoms, or the condition can even be clinically silent. Our aim was to detect coeliac disease patients with such atypical or no symptoms as well as those with typical features. Methods: The incidence of adult coeliac disease in Tampere was calculated from 1975 to 1994 and the prevalence as of 31 December 1994. Open-access endoscopy was available for general practitioners, and small-bowel biopsy was done routinely. Serologic screening was applied to patients with an increased risk of coeliac disease. Results: The incidence of coeliac disease increased tenfold, and the prevalence was 270 per 100, 000 inhabitants in 1994. Twenty per cent were found by serologic screening and 10% as a result of routine biopsy; 24% had dermatitis herpetiformis. Conclusions: Our diagnostic approach gave a coeliac prevalence similar to that found in population screening studies. One-third had silent coeliac disease.

Incidence and prevalence of adult coeliac disease within a defined geographic area in Denmark.

In childhood coeliac disease highly varying incidence rates have recently been disclosed. Very low incidence rates (0.09/1000) were found in Denmark, in contrast to our neighbouring country Sweden (2.93/1000). Whether this was accounted for by the diagnosis being delayed until adult life was unknown. No studies concerning the epidemiology of adult coeliac disease in Denmark have been published so far. The annual incidence rates of adult coeliac disease were determined in the county of Copenhagen during the years 1976-91. The risk of having developed coeliac disease in adult life, on the basis of age and sex, was calculated. The life time prevalences by 5-year birth cohorts were calculated. The overall incidence had been stable during the period and was 1.27/10(5). The figures for females and males were 1.55/10(5) and 0.96/10(5), respectively (p = 0.04). The median (range) age at the time of diagnosis was 40.1 (16-81) years. Age-specific incidence rates varied considerably, with the peak rate located in the middle-aged population. Low incidence rates were demonstrated in teenagers and young adults, and increasing rates was seen again in old age. The incidence rates were influenced by age at diagnosis (p = 0.01) and sex (p = 0.04) but not by the year when diagnosed. For a subject aged 89 years the risk was 0.88/1000. The corresponding figures for males and females, were 0.75/1000 and 1.0/1000, respectively. The overall prevalence was 45.9/10(5); males and females, 35.3/10(5) and 55.8/410(5), respectively. This incidence/prevalence is one of the lowest reported and is definitely lower than prevalences reported in our neighbouring Scandinavian countries. Nothing points to higher incidence rates being present in Danish adults to compensate for the previously demonstrated very low rates in Danish children.

On the prevalence of adult coeliac disease in Sweden.

The occurrence of coeliac disease has been less recognized among adults than in children. We have examined the prevalence of adult coeliac disease in a defined population in Sweden, on the basis of results obtained during 7 years' gastroenterological routine practice. On 1 July 1979, the overall prevalence rate was found to be 58/100,000 (1:1700). The age-adjusted rates were unevenly distributed. The peak rate, 130/100,00 (1:750), appearing in the age interval of 45-54 years, indicates that unrecognized middle-aged coeliacs are not symptom-free and that they can be found in routine practice. Our peak rate of coeliac disease unaccompanied by dermatitis herpetiformis is in the same range as the rate found in Swedish children.