Unusually High Incidence of Paediatric Coeliac Disease in Sweden during the Period 1973 – 2013

Abstract

ObjectiveThe prevalence of coeliac disease in Sweden during the “epidemic period” (1984−1996) was one of the highest in the world. The aim of this study was to assess the coeliac disease incidence in our region over the 41-year period, and how diagnostic activity and diagnostic accuracy were affected by the introduction of antibody testing. We also looked into how patients with mild enteropathy were evaluated.MethodsIn the county of Östergötland in Sweden, 2790 paediatric patients were investigated for suspected coeliac disease between 1973 and 2013. Notes were scrutinised for data on sex, age, histopathological reports and final diagnosis. For comparative purposes this period was divided into three sub-periods (1973−1983, 1984−1996 and 1997−2013) named pre-epidemic, epidemic and post-epidemic.ResultsCoeliac disease diagnosis was received by 1,030 patients. The peak incidence rate, 301 cases/100,000 in 1994 for the age group 0−1.9 years is the highest figure ever reported. The other age groups, 2−4.9, 5−14.9, and 15−17.9 years, also had high incidence rates. After the 1984−1996 “epidemic period” the incidence decreased for the youngest group but continued to increase for the other groups. The cumulative incidence at 18 years-of-age for children born during the epidemic reached 14 cases/1000 births, the highest figure hitherto reported. Diagnostic activity differed significantly between the three sub-periods (p<0.001) increasing gradually from 1984 and reaching a peak value of 0.87 in 2012. Cases of mild enteropathy were more frequently regarded as non-coeliac disease cases, decreasing significantly in the “post-epidemic” period (p<0.001).ConclusionsThe incidence rate and cumulative incidence of coeliac disease were possibly the highest ever reported. Changes in diagnostic activity and accuracy could not be attributed to the introduction of new antibody tests, possibly because of other changes e.g. variations in the symptoms at presentation and improved knowledge of the disease among parents and health professionals.

Evaluation of screening for coeliac disease in children with juvenile idiopathic arthritis

“…However, an earlier Swedish study including a large cohort of 12-year-old children, screened by anti-TG2 antibodies, showed a CD prevalence of 3% (21), but that specific study may have overestimated the prevalence of CD. The study by Myleus et al was performed on children belonging to a birth cohort with an unusually high incidence of CD, sometimes referred to as the 'Swedish celiac epidemic period' (22), and in their criteria used for CD, they included children with small intestinal biopsies only showing increased intraepithelial lymphocytes (Marsh 1) if other symptoms or signs of CD were present, which is not considered as CD according to the ESPGHAN criteria. This makes it difficult to make conclusive comparisons of prevalence with the present study.…”

Frequency of Diagnosed Gastrointestinal & Liver Diseases in Paediatric out Patient Department at a Tertiary Care Hospital of Karachi, Pakistan

“…G.I related diseases include celiac disease which was the most common disease presented to outdoor patient which was found to be 17.8%, where as in an another study it was found to be 7%, which was low In comparison [3] , furthermore there were also underdiagnosed cases of celiac disease, similarly tissue transglutaminase were positive in 61.1% of the patients with celiac disease in our study, whereas Trovato. CM et al in his study reported that paediatric patients with seropositive TTG were 68.5% [13] , patients with the celiac disease develop polyautoimmunity [14] , Unusual high rate of incidence of celiac disease has been reported in study conducted at Sweden, during 40 year time period 1030 patients have celiac disease [15] , another article reported the prevalence of celiac disease which is found to be 4.1% [16] , whereas its frequency among children of Germany is found to be 0.9% [3] .…”

Biomarkers of Inflammation and Intestinal Mucosa Pathology in Celiac Disease

“…person years in 1994 25 . After this period, the CD incidence in Sweden decreased to approximately the same levels as before the epidemic 24 .…”

“…However, the difference seems less pronounced in screening-based studies 31,32 . More recent and local data on incidence rate were presented in a study including children in the Swedish county of Östergötland 25 . The 2013 rate was 50 new cases per 100,000 person years for children and adolescents below 18 years of age.…”