Trends in paediatric coeliac disease 1990-2009: a UK regional retrospective audit of cases

Abstract

Aim To review all incident cases of paediatric coeliac disease (CD) in a UK region over the 20 year period from 1990-2009; to observe trends in incidence, symptom presentation, age at diagnosis and the impact of active screening of at-risk groups; and to audit laboratory results at diagnosis for 01/2005-12/2009. Methods We performed a retrospective audit of case notes, pathology databases, endoscopy and electronic patient records for all children under 16 years diagnosed with CD on duodenal biopsy between 01/1990 and 12/2009 in a UK region of 1.25 million population, of whom 233,000 were aged <16 years of age. Results 266 biopsy positive children were diagnosed during the 20 year study period with a mean increase in age-sex standardised incidence from 1.76 (95% CI 1.08-2.72) to 11.74 (95% CI 9.82-13.93) per 100,000 aged <16 years in the 1990-1994 and 2005-2009 epochs respectively (p=0.001). The median (IQR) age at diagnosis also increased signifi cantly from 29 (16-53.25) months to 90 (53.5-132.5) months in 1990-1994 and 2005-2009 epochs respectively (p<0.0001). 21% of children presented non-classically in 2005-2009 compared to 5% in 1995-1999 (p=0.008); this included children presenting monosymptomatically with one isolated gastrointestinal (GI) symptom and those with extra-intestinal symptoms. 7% of children were diagnosed through targeted screening in 1990-1994 compared to 23% in 2005-2009 (p=0.002). Routine blood investigations demonstrated that over 25% were anaemic and over 50% were iron defi cient at presentation in [2005][2006][2007][2008][2009]. Conclusions The incidence of paediatric CD has increased seven-fold over the last 20 years in a UK region. Children are older at diagnosis, presenting with fewer GI symptoms, and with iron defi ciency anaemia remaining the commonest laboratory abnormality. We suggest that this increase in incidence is largely due to both increased screening of at risk groups and a lower threshold for investigating for CD as a result of greater clinician awareness of the condition's heterogenic nature. A UK-wide study would be benefi cial to identify national trends in incidence and symptomatology.group.bmj.com on July 30, 2012 -Published by adc.bmj.com Downloaded from

Coeliac disease is more common in children with high socio‐economic status

“…There is significant evidence from groups who have studied a variety of chronic diseases that those parents with higher socio‐economic status have more health seeking behaviours than those in lower socio‐economic status groups . Indeed, we know that there is an increasing incidence of children presenting with mild abdominal symptoms , and so it may be possible to suggest that the parents of children in high socio‐economic status areas are more likely to seek advice for minor symptoms of coeliac disease, such as mild abdominal pain than parents who have a lower socio‐economic status. Equally, it is possible that children of high socio‐economic status are more likely to be presented for serological screening if a first degree relative has been diagnosed than in those families from lower socio‐economic status groups.…”

“…Similarly, an unpublished PhD from the Sheffield/Nottingham area found that incidence rate of coeliac disease in adults was twice as high in the least deprived and most affluent quintiles (0.17/1000), compared with those with coeliac disease in the most deprived and poorest quintile (0.07/1000) . Other studies have found no difference between socio‐economic status .…”

“…Coeliac disease is a multisystem disease, with an estimated prevalence of approximately 1% . Its manifestations include a small intestinal enteropathy secondary to exposure to gluten, which is completely reversible on a gluten exclusion diet .…”