Abstract
Objective: To determine the incidence and presenting features of adult coeliac disease in a single university hospital in South Yorkshire.
Design: A retrospective case finding study. Data were obtained from pathology and immunology databases, clinical notes, dietetic records, and patient questionnaires.
Setting: Royal Hallamshire Hospital in South Yorkshire, England.
Participants: All recorded cases of coeliac disease.
Main outcome measures: Crude annual incidence rates for coeliac disease was obtained. The numbers of coeliac antibody profiles requested per year from the Royal Hallamshire Hospital were ascertained. Age at diagnosis, sex, year of diagnosis, presenting symptoms, associated conditions, and delay in diagnosis was documented. In addition the specialty of the clinician who made the diagnosis was noted.
Results: There were 264 cases in total (male n=86, ratio 1:2). Mean age at diagnosis was 44.9 years (range 1–82, median 44.5). A trend was observed from 1990 to 2000 inclusive, of an annual increase in the incidence of coeliac disease. There has been a coincidental increase in the measurement of associated antibodies. Although 28.4% of patients presented with gastrointestinal symptoms, 20.1% had iron deficiency anaemia. The ratio of typical to atypical symptoms was 1:2.5. (single sample test of proportions p<0.001). The diagnosis was made by a gastroenterologist in only 52.7% of cases. The median duration of symptoms before the diagnosis of coeliac disease was 4.9 years (range 0.25–16 years).
Conclusion: Coeliac disease is now presenting more commonly without gastrointestinal symptoms and often to specialties other than gastroenterology. Although more cases are diagnosed, this may be a reflection of increasing recognition rather than a true increase in incidence.
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Selected References
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- Bodé S., Gudmand-Høyer E. Symptoms and haematologic features in consecutive adult coeliac patients. Scand J Gastroenterol. 1996 Jan;31(1):54–60. doi: 10.3109/00365529609031627. [DOI] [PubMed] [Google Scholar]
- Catassi C., Rätsch I. M., Fabiani E., Rossini M., Bordicchia F., Candela F., Coppa G. V., Giorgi P. L. Coeliac disease in the year 2000: exploring the iceberg. Lancet. 1994 Jan 22;343(8891):200–203. doi: 10.1016/s0140-6736(94)90989-x. [DOI] [PubMed] [Google Scholar]
- 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 Nov;32(11):1129–1133. doi: 10.3109/00365529709002992. [DOI] [PubMed] [Google Scholar]
- Collin P., Vilska S., Heinonen P. K., Hällström O., Pikkarainen P. Infertility and coeliac disease. Gut. 1996 Sep;39(3):382–384. doi: 10.1136/gut.39.3.382. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dickey W., Hughes D. Prevalence of celiac disease and its endoscopic markers among patients having routine upper gastrointestinal endoscopy. Am J Gastroenterol. 1999 Aug;94(8):2182–2186. doi: 10.1111/j.1572-0241.1999.01348.x. [DOI] [PubMed] [Google Scholar]
- Feighery C. Fortnightly review: coeliac disease. BMJ. 1999 Jul 24;319(7204):236–239. doi: 10.1136/bmj.319.7204.236. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ferguson A., Arranz E., O'Mahony S. Clinical and pathological spectrum of coeliac disease--active, silent, latent, potential. Gut. 1993 Feb;34(2):150–151. doi: 10.1136/gut.34.2.150. [DOI] [PMC free article] [PubMed] [Google Scholar]
- George E. K., Mearin M. L., Franken H. C., Houwen R. H., Hirasing R. A., Vandenbroucke J. P. Twenty years of childhood coeliac disease in The Netherlands: a rapidly increasing incidence? Gut. 1997 Jan;40(1):61–66. doi: 10.1136/gut.40.1.61. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gregory C., Ashworth M., Eade O. E., Holdstock G., Smith C. L., Wright R. Delay in diagnosis of adult coeliac disease. Digestion. 1983;28(3):201–204. doi: 10.1159/000198987. [DOI] [PubMed] [Google Scholar]
- Hadjivassiliou M., Gibson A., Davies-Jones G. A., Lobo A. J., Stephenson T. J., Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369–371. doi: 10.1016/s0140-6736(96)90540-1. [DOI] [PubMed] [Google Scholar]
- Hawkes N. D., Swift G. L., Smith P. M., Jenkins H. R. Incidence and presentation of coeliac disease in South Glamorgan. Eur J Gastroenterol Hepatol. 2000 Mar;12(3):345–349. doi: 10.1097/00042737-200012030-00013. [DOI] [PubMed] [Google Scholar]
- Hin H., Bird G., Fisher P., Mahy N., Jewell D. Coeliac disease in primary care: case finding study. BMJ. 1999 Jan 16;318(7177):164–167. doi: 10.1136/bmj.318.7177.164. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Holmes G. K., Prior P., Lane M. R., Pope D., Allan R. N. Malignancy in coeliac disease--effect of a gluten free diet. Gut. 1989 Mar;30(3):333–338. doi: 10.1136/gut.30.3.333. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McFarlane X. A., Bhalla A. K., Reeves D. E., Morgan L. M., Robertson D. A. Osteoporosis in treated adult coeliac disease. Gut. 1995 May;36(5):710–714. doi: 10.1136/gut.36.5.710. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Revised criteria for diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition. Arch Dis Child. 1990 Aug;65(8):909–911. doi: 10.1136/adc.65.8.909. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Troncone R., Greco L., Mayer M., Paparo F., Caputo N., Micillo M., Mugione P., Auricchio S. Latent and potential coeliac disease. Acta Paediatr Suppl. 1996 May;412:10–14. doi: 10.1111/j.1651-2227.1996.tb14240.x. [DOI] [PubMed] [Google Scholar]