| Autor: |
Alan R. Zinsmeister, Tricia L. Brantner, Carol T. Van Dyke, Joseph A. Murray, Kevin N. Christensen, Robert A. Kyle, Joseph J. Larson, Lee J. Melton, Deanna L. Brogan, Waleed Brinjikji, Brian D. Lahr, Jonathan D. Godfrey |
| Rok vydání: |
2009 |
| Předmět: |
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| Zdroj: |
Gastroenterology. 136:A-475 |
| ISSN: |
0016-5085 |
| DOI: |
10.1016/s0016-5085(09)62185-5 |
| Popis: |
BACKGROUND: Celiac disease (CD) is a common digestive disease although many cases are unrecognized. Approximately 1% of the general population may have undiagnosed CD but the impact of undiagnosed CD on morbidity and mortality is unknown. AIM: To quantify the morbidity and mortality of undiagnosed CD. METHODS: Stored sera from a populationbased cohort of 16,592 Olmsted County, Minnesota residents comprising 85% of adults ≧50 years of age was screened for CD using sequential testing. Participants with known CD were excluded. Tissue transglutaminase (tTGA) antibodies were tested in all subjects; those positive for tTGA had a confirmatory endomysial antibody (EMA) assay. Undiagnosed CD was defined by the presence of both tTGA and EMA antibodies. A nested case-control study compared these serologically defined CD subjects 1:2 to ageand gender-matched control subjects with negative serology. Complete medical records were reviewed for comorbid conditions by reviewers unaware of serum status. Conditional logistic regression was used to identify factors associated with positive serology. The Kaplan Meier (KM) method was used to estimate overall survival and survival free of subsequent diagnosed CD. RESULTS: We identified 127 (0.75%) subjects with undiagnosedCD. After a median (range) of 10.1 (0.212.5) years of follow-up after serum draw, 20 cases (10-yr KM rate 15%) were subsequently diagnosed with CD and excluded from the final analysis, along with their matched controls; no controls were subsequently diagnosed. The remaining 107 cases (53% male, mean age 64.9) and 214 matched controls were included in the association analysis. Among the >100 conditions assessed, few were significantly associated with serology status. Undiagnosed CD patients had an increased risk of osteoporosis, worse bone density scores, and lower ferritin levels. They also had less arthritis, lower BMI, and lower cholesterol levels. Overall survival was not affected. CONCLUSION: With the exception of impaired bone density, adults over 50 years of age whose CD remained undiagnosed did not demonstrate excess comorbidity or mortality compared to controls. In patients with undiagnosed CD over the age of 50 years, ~15% will be diagnosed with CD within 10 years. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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