Mortality in coeliac disease: a population-based cohort study from a single centre in Southern Derbyshire, UK

Holmes, Geoffrey; Muirhead, Andrew

doi:10.1136/bmjgast-2018-000201

Cited by 24 publications

(27 citation statements)

References 32 publications

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“…Similar to most studies, 1 , 4 , 5 , 11 we have confirmed that the mortality risks in CD patients are greatest during the first few years after diagnosis. It is plausible that at the time of diagnosis, patients in our cohort (all of whom were diagnosed prior to 1984) were more symptomatic and presented with more severe forms of the disease, as has been hypothesised to be the case with patients diagnosed in the pre‐serological era 8 , 22 . This coincides with the recognition that diagnosis at this time was more difficult than what it has become with serology and endoscopic biopsy.…”

Section: Discussionsupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

“…Coeliac disease (CD) patients are reported to have a higher mortality risk than the general population, although the reported magnitude of this increase in risk varies widely. [1][2][3][4][5][6][7][8] There is consensus that these increased mortality risks are observed predominantly within a few years of diagnosis (1-4 years). 1,[4][5][6] Owing to limited follow-up, the majority of studies have not been able to assess whether these risks persist for long periods (>20 years) after diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Mortality in people with coeliac disease: Long‐term follow‐up from a Scottish cohort

et al. 2019

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Background: Few studies have determined the very long-term mortality risks in adult and childhood-diagnosed coeliac disease. Objective: We quantified mortality risks in coeliac disease and determined whether age at diagnosis, or time following diagnosis, modified these risks. Methods: Standardised mortality ratios were determined using data from a cohort of 602 coeliac patients assembled between 1979-1983 from Lothian, Scotland, and followed up from 1970-2016. Results: All-cause mortality was 43% higher than in the general population. Excess deaths were primarily from haematological malignancies (standardised mortality ratio, 4.77) and external causes (standardised mortality ratio, 2.62) in adult and childhood-diagnosed cases respectively. Mortality risks declined steadily with time in adult-diagnosed cases (standardised mortality ratio, 4.85 in first year compared to 0.97, 25 years post-diagnosis). Beyond 15 years, this group had a significantly reduced risk of any malignancy (standardised mortality ratio, 0.57 (95% confidence interval: 0.33-0.92)). In contrast, for childhood-diagnosed cases an increased risk existed beyond 25 years (standardised mortality ratio, 2.24). Conclusions: Adult-diagnosed coeliac patients have a temporarily increased mortality risk mainly from malignant lymphomas and a decreased risk of any malignancy beyond 15 years post-diagnosis. In contrast, childhood-diagnosed cases are at an increased risk of mortality mainly from external causes, and have long-term mortality risks that requires further investigation.

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Section: Discussionsupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mortality in people with coeliac disease: Long‐term follow‐up from a Scottish cohort

et al. 2019

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“…Moreover, a study done on a UK population did not reveal an increased risk of cardiovascular death in celiac patients compared to the general population (standardized mortality ratio: 1.23; 95% CI 0.98-1.51). However, the standardized mortality ratio was greater during the post-diagnosis period (after 2 years) than during the peri-diagnosis period (within 2 years) in CD patients [61].…”

Section: Discussionmentioning

confidence: 84%

Celiac Disease, Gluten-Free Diet, and Metabolic and Liver Disorders

et al. 2020

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Celiac disease (CD) is a chronic autoimmune enteropathy triggered by the ingestion of gluten in genetically predisposed individuals. At the time of diagnosis, the frequency of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis in individuals with CD appears to be similar to that of the general population, although a lower body mass index and a lower rate of hypercholesterolemia and type 2 diabetes mellitus are observed at diagnosis in CD patients. The effect of a gluten-free diet (GFD) in individuals with these liver and metabolic disorders is still a matter of debate. The aim of this study was to investigate the links between a GFD and metabolic/liver disorders in CD patients. A systematic electronic search of the literature from January 2009 to December 2019 was performed using Medline, Web of Science, Scopus, and the Cochrane Library. Only papers written in English concerning metabolic and liver disorders in adult patients with CD were included. Out of 1195 citations, 14 eligible studies were identified. Increases in the frequency of NAFLD, weight gain, and alterations of the lipid profile suggest that important changes happen in celiac patients on a GFD, though the physiopathology of these conditions is unclear. Although a GFD is the only effective treatment available for CD, liver function, body weight, and metabolic and nutritional profiles should be monitored in patients on a GFD.

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“…1 lymphoma and adenocarcinoma. [5][6][7][8] Good adherence to a GFD can prevent the development of at least some of these complications. 7 With increasing pressure on the availability of gastroenterology outpatient clinic capacity many hospitals have elected to discharge patients with well controlled coeliac disease back to their general practitioners (GPs).…”

Section: Introductionmentioning

confidence: 99%

Comparing alternative follow-up strategies for patients with stable coeliac disease

Pritchard

Waters

Murray

et al. 2019

Frontline Gastroenterol

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BackgroundOnce clinically stable, patients with coeliac disease should have annual follow-up. Lack of capacity in gastroenterology outpatient clinics mean alternatives are required.ObjectivesWe studied the effectiveness of follow-up deferred to general practitioners (GP-FU) and compared this with a neighbouring Trust where follow-up was through a dedicated nurse-led telephone clinic (T-FU).DesignAll patients with coeliac disease were posted a questionnaire examining patient satisfaction, adherence with gluten-free diet and calcium intake.Results517 of 825 patients (62.7%) completed a postal questionnaire (median age 61, 72% female). 28% of GP-FU and 84% of T-FU patients received an annual review. Of those seen, 33% (GP-FU) and 53% (T-FU) were weighed (χ2 65.8, p<0.001), 44% and 63% had symptom review (χ2 81.1, p<0.001) and 33% and 51% had dietary adherence checked (χ2 60.6, p<0.001). Almost all patients considered their adherence with gluten-free diet (GFD) good or excellent, although the majority of patients failed to achieve the recommended daily intake of calcium. GP-FU patients were more likely to receive calcium±vitamin D supplements (77% vs 42%, χ2 88.2, p<0.001) and they were also more likely to receive appropriate vaccinations (67% vs 38%, χ2 17.6, p<0.001).ConclusionsDischarge of patients with coeliac disease to primary-care in many cases results in their complete loss to follow-up. When patients were reviewed, either by GP-FU and T-FU, many aspects of their care are not addressed. Whether this will result in late complications remains to be seen.

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Mortality in coeliac disease: a population-based cohort study from a single centre in Southern Derbyshire, UK

Cited by 24 publications

References 32 publications

Mortality in people with coeliac disease: Long‐term follow‐up from a Scottish cohort

Mortality in people with coeliac disease: Long‐term follow‐up from a Scottish cohort

Celiac Disease, Gluten-Free Diet, and Metabolic and Liver Disorders

Comparing alternative follow-up strategies for patients with stable coeliac disease

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