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Nationwide study of childhood celiac disease incidence over a 35-year period in Estonia

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Abstract

The aims of the study were to analyze the trends and characteristics of the incidence and clinical presentation of childhood celiac disease (CD) from 1976 to 2010 in Estonia. The study included all children up to 19 years of age diagnosed with small bowel biopsy proven CD. During a 35-year period, CD was diagnosed in 152 children in Estonia (68 boys, median age 2.3 years). From 1976 to 1980, the age-standardized incidence rate of CD was 0.10 per 100,000 person-years. After the introduction of gliadin and endomysium antibody screening (in conjunction with activities directed to increase the physicians awareness), the incidence rate increased from 0.48 in 1986–1990 to 1.55 per 100,000 person-years in 1991–1995. After initiating screening with anti-tissue transglutaminase antibodies in 2003 and routine screening for CD among all children with newly diagnosed type 1 diabetes in 2005, the incidence rate increased from 1.59 in 2001–2005 to 3.14 per 100,000 person-years in 2006–2010 (median age 6.8 years). Our nationwide study demonstrates a more than 30-fold increase in the incidence of childhood CD over a 35-year period in Estonia, along with changing patterns in the presentation of pediatric CD. In addition to the impact of use of novel CD screening methods, active search and rising of the awareness among doctors may have strongest effect. Both environmental and social factors could be also involved in the increase in CD incidence.

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References

  1. Giongo A, Gano KA, Crabb DB, Mukherjee N, Novelo LL, Casella G, Drew JC, Ilonen J, Knip M, Hyöty H, Veijola R, Simell T, Simell O, Neu J, Wasserfall CH, Schatz D, Atkinson MA, Triplett EW (2011) Toward defining the autoimmune microbiome for type 1 diabetes. ISME J 5:82–91

    Article  PubMed  CAS  Google Scholar 

  2. Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, Troncone R, Giersiepen K, Branski D, Catassi C, Lelgeman M, Mäki M, Ribes-Koninckx C, Ventura A, Zimmer KP, for the ESPGHAN Working Group on Coeliac Disease Diagnosis on behalf of the ESPGHAN Gastroenterology Committee (2012) European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease. J Pediatr Gastroenterol Nutr 54:136–160

    Article  PubMed  CAS  Google Scholar 

  3. Kneepkens CMF, von Blomberg BME (2012) Coeliac disease. Eur J Pediatr 171:1011–1021

    Article  PubMed  Google Scholar 

  4. Kondrashova A, Mustalahti K, Kaukinen K, Viskari H, Volodicheva V, Haapala AM, Ilonen J, Knip M, Mäki M, Hyöty H, Epivir Study Group (2008) Lower economic status and inferior hygienic environment may protect against celiac disease. Ann Med 40:223–231

    Article  PubMed  Google Scholar 

  5. Lillemäe K, Ress K, Harro J, Merenäkk L, Maaroos HI, Uibo R, Uibo O (2012) A 10-year serological follow-up of celiac disease in an Estonian population. Eur J Gastroenterol Hepatol 24:55–58

    Article  PubMed  Google Scholar 

  6. Lohi S, Mustalahti K, Kaukinen K, Laurila K, Collin P, Rissanen H, Lohi O, Bravi E, Gasparin M, Reunanen A, Mäki M (2007) Increasing prevalence of coeliac disease over time. Aliment Pharmacol Ther 26:1217–1225

    Article  PubMed  CAS  Google Scholar 

  7. McGowan KE, Castiglione DA, Butzner JD (2009) The changing face of childhood celiac disease in North America: impact of serological testing. Pediatrics 124:1572–1578

    Article  PubMed  Google Scholar 

  8. Meresse B, Malamut G, Cerf-Bensussan N (2012) Celiac disease: an immunological jigsaw. Immunity 36:907–919

    Article  PubMed  CAS  Google Scholar 

  9. Mitt K, Uibo O (1998) Low cereal intake in Estonian infants: the possible explanation for the low frequency of coeliac disease in Estonia. Eur J Clin Nutr 52:85–88

    Article  PubMed  CAS  Google Scholar 

  10. Mustalahti K, Catassi C, Reunanen A, Fabiani E, Heier M, McMillan S, Murray L, Metzger MH, Casparin M, Bravi E, Mäki M (2010) The prevalence of celiac disease in Europe: results of a centralized international mass screening project. Ann Med 42:587–595

    Article  PubMed  Google Scholar 

  11. Myléus A, Ivarsson A, Webb C, Danielsson L, Hernell O, Högberg L, Karlsson E, Lagerqvist C, Norström F, Rosén A, Sandström O, Stenhammar L, Stenlund H, Wall S, Carlsson A (2009) Celiac disease revealed in 3 % of Swedish 12-year-olds born during an epidemic. J Pediatr Gastroenterol Nutr 49:170–176

    Article  PubMed  Google Scholar 

  12. Reilly NR, Green PH (2012) Epidemiology and clinical presentations of celiac disease. Semin Immunopathol. doi:10.1007/s00281-012-0311-2

  13. Ress K, Harro M, Maaroos HI, Harro J, Uibo R, Uibo O (2007) High prevalence of coeliac disease: need for increasing awareness among physicians. Dig Liver Dis 39:136–139

    Article  PubMed  CAS  Google Scholar 

  14. Roma E, Panayiotou J, Karantana H, Constantinidou C, Siakavellas SI, Krini M, Syriopoulou VP, Bamias G (2009) Changing pattern in the clinical presentation of pediatric celiac disease: a 30-year study. Digestion 80:185–191

    Article  PubMed  Google Scholar 

  15. Sepp E, Julge K, Vasar M, Naaber P, Bjorksten B, Mikelsaar M (1997) Intestinal microflora of Estonian and Swedish infants. Acta Paediatr 86:956–961

    Article  PubMed  CAS  Google Scholar 

  16. Stene LC, Honeyman MC, Hoffenberg EJ, Haas JE, Sokol RJ, Emery L, Taki I, Norris JM, Erlich HA, Eisenbarth GS, Rewers M (2006) Rotavirus infection frequency and risk of celiac disease autoimmunity in early childhood: a longitudinal study. Am J Gastroenterol 101:2333–2340

    Article  PubMed  CAS  Google Scholar 

  17. Teeäär T, Liivak N, Heilman K, Kool P, Šor R, Paal M, Einberg U, Tillmann V (2010) Increasing incidence of childhood-onset type 1 diabetes mellitus among Estonian children in 1999–2006. Time trend analysis 1983–2006. Pediatr Diabetes 11:107–110

    Article  PubMed  Google Scholar 

  18. Uibo O (1994) Childhood celiac disease in Estonia: efficacy of the IgA-class antigliadin antibody test in the search for new cases. J Pediatr Gastroenterol Nutr 18:53–55

    Article  PubMed  CAS  Google Scholar 

  19. Uibo O, Maaroos HI (1993) Hospital screening of coeliac disease in Estonian children by anti-gliadin antibodies of IgA class. Acta Paediatr 82:233–234

    Article  PubMed  CAS  Google Scholar 

  20. Uibo O, Metsküla K, Kukk T, Rägo T, Uibo R (1996) Results of coeliac disease screening in Estonia in 1990–1994. Acta Paediatr 412:39–41

    Article  CAS  Google Scholar 

  21. Uibo R, Talja I, Jõgi T, Janson C, Björnsson B, Boman G, Mandel M, Björksten B (1998) Autoantibodies in Estonia and Sweden, populations with different response to allergens. Int Arch Allergy Immunol 117:126–130

    Article  PubMed  CAS  Google Scholar 

  22. Van den Broeck HC, de Jong HC, Salentijn EM, Dekking L, Bosch D, Hamer RJ, Gilissen LJ, van der Meer IM, Smulders MJ (2010) Presence of celiac disease epitopes in modern and old hexaploid wheat varieties: wheat breeding may have contributed to increased prevalence of celiac disease. Theor Appl Genet 121:1527–1539

    Article  PubMed  Google Scholar 

  23. Volta U, Bellentani S, Bianchi FB, Brandi G, De Franceschi L, Miglioli L, Granito A, Balli F, Tiribelli C (2001) High prevalence of celiac disease in Italian general population. Dig Dis Sci 46:1500–1505

    Article  PubMed  CAS  Google Scholar 

  24. Walker-Smith JA, Guandalini S, Schmitz J, Shmerling DH, Visakorpi JK (1990) Revised criteria for diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition. Arch Dis Child 65:909–911

    Article  Google Scholar 

  25. Wingren CJ, Björck S, Lynch KF, Ohlsson H, Agardh D, Merlo J (2012) Coeliac disease in children: a social epidemiological study in Sweden. Acta Paediatr 1010:185–189

    Article  Google Scholar 

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Acknowledgments

The authors thank the children and their parents for taking part in this study and Katrin Lang, MD, MPH, PhD, for fruitful discussions. This study was funded by Estonian Science Foundation (grant number 8334). The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

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We declare that we have no conflicts of interest.

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Correspondence to Oivi Uibo.

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Ress, K., Luts, K., Rägo, T. et al. Nationwide study of childhood celiac disease incidence over a 35-year period in Estonia. Eur J Pediatr 171, 1823–1828 (2012). https://doi.org/10.1007/s00431-012-1835-0

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  • DOI: https://doi.org/10.1007/s00431-012-1835-0

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