Prognosis of unrecognized coeliac disease as regards mortality: A population-based cohort study

Abstract

The prognosis of unrecognized coeliac disease was good as regards overall mortality, which does not support screening of asymptomatic coeliac disease cases.

Morbidity and Mortality Among Older Individuals With Undiagnosed Celiac Disease

“…33 This is in contrast to a recent study by Rubio-Tapia et al 31 who found a 4-fold increased risk of death for undiagnosed CD among a younger cohort (age 18-24 years at the time of blood draw) with follow-up over 45 years. Possible explanations for this difference exist.…”

“…31,32 However, a recent study from Finland in adults with a mean age of 50 suggested the prognosis of adults with unrecognized CD appeared to be good, except for a significantly increased risk for lymphoma and esophageal carcinoma. 33 Consequently, it is of crucial importance to know the impact that undetected, and hence untreated, CD has in older adults. This information could have profound implications for public health decisions and could help answer questions regarding the prognosis for patients in whom CD is detected in the absence of substantial gastrointestinal symptoms or other consequences of the disease.…”

Diagnosis of Celiac Disease

“…In a second cohort study, healthy volunteers with a positive TTG had an increased mortality compared to seronegative subjects (HR 2.53; 95% CI 1.50-4.25). 15 But in four other studies in England, 16 Finland, 17 Ireland, 18 and individuals older than 50 in Olmsted county, 19 no increase in mortality was noted in undiagnosed seropositive individuals as compared to their seronegative counterparts. A recent metaanalysis found a modestly increased mortality risk in patients with CD based on serology alone (OR 1.16; 95% CI 1.02-1.31), 20 but this pooled analysis included seropositive patients who underwent small intestinal biopsy that was normal, 10 raising the possibility of confounding by indication.…”

Commentary: coeliac disease, mortality and malignancy

“…With the exception of the Rubio-Tapia study, 2 most studies on undiagnosed coeliac disease do not show an increased risk of death. [3][4][5] This lack of excess mortality has implications for general populationbased screening for coeliac disease. The authors miss the opportunity to calculate an overall relative risk for death and malignancy in undiagnosed coeliac disease.…”

“…[3][4][5] Our serology-only mortality analysis includes the screening studies but also includes Ludvigsson et al 6 which examined a population of serology-positive, biopsy-negative patients that were not screened. In contrast to the screening studies, Ludvigsson et al found that serology-positive, biopsy-negative patients had an increased risk of mortality.…”