Incidence and Prevalence of Celiac Disease and Dermatitis Herpetiformis in the UK Over Two Decades: Population-Based Study

Abstract

OBJECTIVES:Few studies have quantified the incidence and prevalence of celiac disease (CD) and dermatitis herpetiformis (DH) nationally and regionally by time and age groups. Understanding this epidemiology is crucial for hypothesizing about causes and quantifying the burden of disease.METHODS:Patients with CD or DH were identified in the Clinical Practice Research Datalink between 1990 and 2011. Incidence rates and prevalence were calculated by age, sex, year, and region of residence. Incidence rate ratios (IRR) adjusted for age, sex, and region were calculated with Poisson regression.RESULTS:A total of 9,087 incident cases of CD and 809 incident cases of DH were identified. Between 1990 and 2011, the incidence rate of CD increased from 5.2 per 100,000 (95% confidence interval (CI), 3.8–6.8) to 19.1 per 100,000 person-years (95% CI, 17.8–20.5; IRR, 3.6; 95% CI, 2.7–4.8). The incidence of DH decreased over the same time period from 1.8 per 100,000 to 0.8 per 100,000 person-years (average annual IRR, 0.96; 95% CI, 0.94–0.97). The absolute incidence of CD per 100,000 person-years ranged from 22.3 in Northern Ireland to 10 in London. There were large regional variations in prevalence for CD but not DH.CONCLUSIONS:We found a fourfold increase in the incidence of CD in the United Kingdom over 22 years, with large regional variations in prevalence. This contrasted with a 4% annual decrease in the incidence of DH, with minimal regional variations in prevalence. These contrasts could reflect differences in diagnosis between CD (serological diagnosis and case finding) and DH (symptomatic presentation) or the possibility that diagnosing and treating CD prevents the development of DH.

Incidence and distribution of coeliac disease in Campania (Italy): 2011–2013

“…We reported only 6.5% of diagnoses in patients over the age of 50 years, which is lower compared with that reported from the previous literature. 11,21 This may be related to the fact that clinical presentation in adults is more frequently characterized by non-classical presentation, 20 often without any gastrointestinal symptoms 22 and therefore still not recognized by GPs in our region, rather than a true difference in the incidence. In addition, there is an unequal distribution of CD centres among the provinces, with the highest number …”

“…Epidemiological studies have described a two-to sixfold increase in the incidence of coeliac disease (CD) in the populations of Western countries 1 in the last two decades; however, there exists a wide variation of the reported CD incidence since the year 2000, possibly due to differences in the study populations and ascertainment of cases in these countries, [2][3][4][5][6][7][8][9][10][11] but the data from Italy come only from small studies. In Italy, coeliac patients need to receive a disease certificate from secondary outpatient clinics to benefit from a monthly payment to spend on gluten-free food.…”

Clinical and Immunologic Features of Ultra-Short Celiac Disease

“…A recent UK study demonstrated that only 1 in 4 patients with celiac disease are currently diagnosed. 4 Cohorts from the international literature have reported significant delays in diagnosis ranging from 4 to 13 years. 5,6 Furthermore 5-13.6% of patients with newly diagnosed celiac disease have had a prior endoscopy where the chance to diagnose celiac disease was missed.…”

Diagnostic accuracy of red blood cell distribution width-to-lymphocyte ratio for celiac disease

“…Despite significant efforts made in the last decades by increasing awareness among both medical professionals and non-professionals, improving availability of serological testing, development of point-of-care tests and case-finding strategies (1), celiac disease (CD) remains heavily underdiagnosed (2). Undiagnosed CD is associated with risk of complications and poor quality of life which could be avoided by gluten-free diet (3,4).…”