Gastroenterology

Gastroenterology

Volume 152, Issue 4, March 2017, Pages 830-839.e5
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
Prevalence and Morbidity of Undiagnosed Celiac Disease From a Community-Based Study

https://doi.org/10.1053/j.gastro.2016.11.043Get rights and content

Background & Aims

Little is known about the prevalence and burden of undiagnosed celiac disease in individuals younger than age 50. We determined the prevalence and morbidity of undiagnosed celiac disease in individuals younger than age 50 in a community.

Methods

We tested sera from 31,255 residents of Olmsted County, Minnesota (<50 y), without a prior diagnosis of celiac disease assay using an assay for IgA against tissue transglutaminase; in subjects with positive test results, celiac disease was confirmed using an assay for endomysial IgA. We performed a nested case–control study to compare the proportion of comorbidities between undiagnosed cases of celiac disease and age- and sex-matched seronegative controls (1:2). Medical records were abstracted to identify potential comorbidities.

Results

We identified 338 of 30,425 adults with positive results from both serologic tests. Based on this finding, we estimated the prevalence of celiac disease to be 1.1% (95% confidence interval, 1.0%–1.2%); 8 of 830 children tested positive for IgA against tissue transglutaminase (1.0%; 95% confidence interval, 0.4%–1.9%). No typical symptoms or classic consequences of diagnosed celiac disease (diarrhea, anemia, or fracture) were associated with undiagnosed celiac disease. Undiagnosed celiac disease was associated with increased rates of hypothyroidism (odds ratio, 2.2; P < .01) and a lower than average cholesterol level (P = .03) and ferritin level (P = .01). During a median follow-up period of 6.3 years, the cumulative incidence of a subsequent diagnosis with celiac disease at 5 years after testing was 10.8% in persons with undiagnosed celiac disease vs 0.1% in seronegative persons (P < .01). Celiac disease status was not associated with overall survival.

Conclusions

Based on serologic tests of a community population for celiac disease, we estimated the prevalence of undiagnosed celiac disease to be 1.1%. Undiagnosed celiac disease appeared to be clinically silent and remained undetected, but long-term outcomes have not been determined.

Section snippets

Materials and Methods

This study was a community-based, nested, case–control study of individuals younger than age 50, whose waste blood samples were tested for antibodies associated with celiac disease in 2006–2011. Our study was approved by the institutional review boards of Mayo Clinic and Olmsted Medical Center, Rochester, Minnesota.

Prevalence of Undiagnosed Celiac disease

From residents (ages, 18–50 y) of Olmsted County who sought health care at Mayo Clinic from 2006 through 2011, we obtained and tested waste serum samples of 30,425 individuals. In total, 372 individuals (1.2%) tested positive for tTGA (≥4.0 U/mL), 241 (0.8%) had borderline tTGA levels (2.0 ≤ tTG < 4.0 U/mL), and 29,812 (98.0%) tested negative. Those with a positive or borderline tTGA result underwent confirmatory EMA testing. On the basis of a combined serology status of tTGA and EMA results,

Discussion

In this large, community-based cohort of health care–attending adults ages 18–50 years, the prevalence of undiagnosed celiac disease was 1.1% (95% CI, 1.0%–1.2%), which is similar to other epidemiologic data in the United States.19, 35 This was a large, comprehensively analyzed study on comorbid conditions in adults ages 18–50 years with undiagnosed celiac disease. We found that undiagnosed celiac disease was associated with subtle differences in nutrition, including decreased levels of

Acknowledgment

The authors acknowledge the expert assistance of Tricia L. Branter for serologic testing.

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    This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e17. Learning Objective: Upon completion of this CME activity successful learners will be able to describe the prevalence and morbidity of undiagnosed celiac disease.

    Conflicts of interest This author discloses the following: Joseph Murray has received grant support from the National Institutes of Health and Alba Therapeutics; receives ongoing support from the Oberkotter Foundation; serves on the advisory board of Celimmune, LLC; has served as a consultant to AMAG Pharmaceuticals, Entera Health, Inc, Sonomaceuticals, LLC, BioLineRx, GlaxoSmithKline, Genentech, and Glenmark Pharmaceuticals Ltd; serves as a consultant to Boehringer Ingelheim; has a patent with Miomics; and has equity options in Torax. The remaining authors disclose no conflicts.

    Funding Supported in part by a grant from the National Institutes of Health (R01DK057892) and by the Mayo Foundation for Medical Education and Research. This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health (R01AG034676). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    Author names in bold designate shared co-first authorship.

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