Different features of coeliac disease in two neighbouring countries.

Ascher, Henry; Holm, K; Kristiansson, Bengt; Maki, M

doi:10.1136/adc.69.3.375

Cited by 82 publications

(55 citation statements)

References 21 publications

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“…This result coincides with data reported from other countries but also from Sweden, suggesting similar increase (Mc Gowan 2009, Savilahti 2010, Tanpowpong 2012, Namatovu 2014. It is worth mentioning that the increase of mean age at diagnosis for the neighboring Finnish children preceded the Swedish dito observed after the epidemic period (Ascher 1993). On the contrary, the age at diagnosis remains low, i.e.…”

Section: Paper I Age and Sex Distributionsupporting

confidence: 77%

Demographics, clinical features and treatment of pediatric celiac disease

Tapsas¹

2015

Linköping University Medical Dissertations

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Celiac disease (CD) is a chronic small intestinal immune-mediated enteropathy triggered by ingestion of gluten-containing food in genetically predisposed subjects. The enteropathy is presented with a wide variety of clinical manifestations, which can occur even outside the gastrointestinal tract. In the majority of cases, the diagnosis of CD is based on a small intestinal biopsy showing mucosal alterations, i.e. intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy. The treatment, gluten-free diet (GFD), has recently been revised with the addition of gluten-free oats. Oats give a more diversified nutrition and increase the fibre content. The use of oats in CD is though still debated in some reports. A strict life-long adherence to the GFD can be problematic, especially for pediatric CD patients. Sweden reported of one of the highest observed CD prevalences worldwide, i.e. 3%, among 12-year-olds born during what has been described as "the Swedish celiac epidemic", 1984−1996.The aims of this thesis were to elucidate how pediatric CD has changed during a 41-year period in Sweden, i.e. 1973Sweden, i.e. −2013, in terms of clinical presentation, disease severity, incidence, and demographics. We also wanted to adress the compliance to the GFD, the use of oats in the GFD and the safety of oats inclusion in the diet by measuring urinary nitric oxide (NO) metabolites.Filed information provided data about 2856 pediatric patients investigated for suspected CD between 1973 and 2013; of which 1030 patients were diagnosed with CD. After the data analyses the mean age of CD patients was shown to increase after the celiac epidemic period.Currently, CD shows a less severe picture in terms of symptoms and intestinal pathology.Younger children suffer primarily from gastrointestinal symptoms and growth failure, whereas extra-intestinal manifestations are more often displayed among adolescents. viWe also reported an unusually high pediatric CD incidence rate and cumulative incidence, likely the highest reported worldwide. We hypothesised that the introduction of new antibody tests would affect the diagnostic activity and accuracy in performing small intestinal biopsies for CD investigation. However, the outcome of diagnostic activity and accuracy could not clearly be attributed to the use of antibody tests due to changes occurring in parallel during the 41-year study period, e.g. a different pattern of symptoms at presentation and improved knowledge of the disease among parents and health professionals.In a questionnaire-based study our patient group reported a high compliance to the GFD.Long duration of the GFD may, however, influence compliance negatively. Oats have been included to the GFD of our study population in most of the cases without reporting major complications related to their well-being.The urinary measurements of NO metabolites revealed two patient groups, one with high and one with low levels. The two populations did not differ regarding sex, age, compliance to the GFD or oats consumption. Fa...

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Section: Paper I Age and Sex Distributionsupporting

confidence: 77%

Demographics, clinical features and treatment of pediatric celiac disease

Tapsas¹

2015

Linköping University Medical Dissertations

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“…Studies showed a higher gluten consumption in Swedish infants compared to countries with a lower incidence and to earlier Swedish studies. 34 Also, a higher frequency of terminated breast feeding before the gluten introduction in children with diagnosed CD versus controls was found. 35 The question whether these environmental factors are affecting the phenotype (ie, the intensity of the symptoms), and thus, the chance of being diagnosed rather than triggering the onset of the disease has been under debate.…”

Section: Epidemiology Population Geneticsmentioning

confidence: 95%

Searching for genes influencing a complex disease: the case of coeliac disease

et al. 2007

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Recently, a few genes have been reported to be causative in inflammatory diseases. Still, we are waiting for the vast majority to be discovered. New tools for genotyping and statistical analysis have been developed and emphasis has been put on study design. Coeliac disease (CD) is a disorder, where prolamins in dietary wheat gluten and related proteins from rye or barley are not tolerated. It is one of the most common chronic diseases in humans exceeding a population prevalence of 1%. In this article, we will summarise what is currently known about the genetics influencing CD with the emphasis on the non-HLA genetic component. We will discuss some difficulties when searching for susceptibility genes in disorders with complex inheritance patterns.

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“…Our study results were compared with the literature data concerning the intake of wheat, rye, barley and oats in Finland and Sweden at the age of 12 months (Ascher et al, 1993).…”

Section: Methodsmentioning

confidence: 96%

“…Nevertheless, despite the active search for cases in different population groups in 1990± 1994, Estonia can be classi®ed as a country with low incidence of CD (0.37 per 1000 live births; Uibo et al, 1993Uibo et al, , 1996Uibo 1994). Despite of the active search of cases of CD, correct diagnostic criteria and also reliable serological CD screening tests, the frequency of CD in Estonia is approximately 10 times lower compared with data obtained for most European countries (Cavell et al, 1992;Ascher et al, 1993;Catassi et al, 1996), being 12 times lower than in Sweden (4.3 per 1000; Cavell et al, 1992;Ascher et al, 1993) and 10 times lower than in Italy (3.9 per 1000; Catassi et al, 1996) Therefore, the question arises of the reasons for such a low frequency of CD in Estonia.…”

Section: Introductionmentioning

confidence: 91%

Low cereal intake in Estonian infants: the possible explanation for the low frequency of coeliac disease in Estonia

Mitt

Uibo

1998

Eur J Clin Nutr

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Objective: The aim of this study was to analyse the intake of coeliac disease (CD) inducing, gluten containing cereals (wheat, rye, barley and oats) in Estonian infants diet and compare these results with neighbouring countries with different CD incidence rate. Design: Study group consisted of 32 healthy full term infants of Estonian origin. Settings: Study was carried out in Tartu University Women's Hospital and in Tartu University Children's Hospital. These are both primary care facilities. Subjects: Infants were recruited to the study group according to their health parameters and parents agreement to take part of this study. Material of this article is based on one part of Estonian infants dietary habits investigation. Results: The total amount of gluten containing cereals in Estonian infants diet was lower than in Sweden and Finland. We found that there is a certain parallelism between CD incidence and cereal intake. Wheat intake of Estonian infants was very close to Finnish infants, but almost twice lower than in Swedish infants. Conclusion: Data from the study is consistent with the hypothesis that gluten intake during infancy play role in development of CD. The quality of gluten-containing cereals may have important part in the development of the disease.

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Different features of coeliac disease in two neighbouring countries.

Cited by 82 publications

References 21 publications

Demographics, clinical features and treatment of pediatric celiac disease

Demographics, clinical features and treatment of pediatric celiac disease

Searching for genes influencing a complex disease: the case of coeliac disease

Low cereal intake in Estonian infants: the possible explanation for the low frequency of coeliac disease in Estonia

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