Increased Prevalence and Mortality in Undiagnosed Celiac Disease

Alberto Rubio-Tapia, Robert A. Kyle, Edward L. Kaplan, Dwight R. Johnson, William Page, Frederick Erdtmann, Tricia L. Brantner, W. Ray Kim, Tara K. Phelps, Brian D. Lahr, Alan R. Zinsmeister, L. Joseph Melton, Joseph A Murray

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Abstract

Background & Aims: The historical prevalence and long-term outcome of undiagnosed celiac disease (CD) are unknown. We investigated the long-term outcome of undiagnosed CD and whether the prevalence of undiagnosed CD has changed during the past 50 years. Methods: This study included 9133 healthy young adults at Warren Air Force Base (sera were collected between 1948 and 1954) and 12,768 gender-matched subjects from 2 recent cohorts from Olmsted County, Minnesota, with either similar years of birth (n = 5558) or age at sampling (n = 7210) to that of the Air Force cohort. Sera were tested for tissue transglutaminase and, if abnormal, for endomysial antibodies. Survival was measured during a follow-up period of 45 years in the Air Force cohort. The prevalence of undiagnosed CD between the Air Force cohort and recent cohorts was compared. Results: Of 9133 persons from the Air Force cohort, 14 (0.2%) had undiagnosed CD. In this cohort, during 45 years of follow-up, all-cause mortality was greater in persons with undiagnosed CD than among those who were seronegative (hazard ratio = 3.9; 95% confidence interval, 2.0-7.5; P < .001). Undiagnosed CD was found in 68 (0.9%) persons with similar age at sampling and 46 (0.8%) persons with similar years of birth. The rate of undiagnosed CD was 4.5-fold and 4-fold greater in the recent cohorts, respectively, than in the Air Force cohort (both P ≤ .0001). Conclusions: During 45 years of follow-up, undiagnosed CD was associated with a nearly 4-fold increased risk of death. The prevalence of undiagnosed CD seems to have increased dramatically in the United States during the past 50 years.

Original languageEnglish (US)
Pages (from-to)88-93
Number of pages6
JournalGastroenterology
Volume137
Issue number1
DOIs
StatePublished - Jul 2009

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Celiac Disease
Mortality
Air
Parturition
Serum
Young Adult
Confidence Intervals
Survival
Antibodies

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Rubio-Tapia, A., Kyle, R. A., Kaplan, E. L., Johnson, D. R., Page, W., Erdtmann, F., ... Murray, J. A. (2009). Increased Prevalence and Mortality in Undiagnosed Celiac Disease. Gastroenterology, 137(1), 88-93. https://doi.org/10.1053/j.gastro.2009.03.059

Increased Prevalence and Mortality in Undiagnosed Celiac Disease. / Rubio-Tapia, Alberto; Kyle, Robert A.; Kaplan, Edward L.; Johnson, Dwight R.; Page, William; Erdtmann, Frederick; Brantner, Tricia L.; Kim, W. Ray; Phelps, Tara K.; Lahr, Brian D.; Zinsmeister, Alan R.; Melton, L. Joseph; Murray, Joseph A.

In: Gastroenterology, Vol. 137, No. 1, 07.2009, p. 88-93.

Research output: Contribution to journalArticle

Rubio-Tapia, A, Kyle, RA, Kaplan, EL, Johnson, DR, Page, W, Erdtmann, F, Brantner, TL, Kim, WR, Phelps, TK, Lahr, BD, Zinsmeister, AR, Melton, LJ & Murray, JA 2009, 'Increased Prevalence and Mortality in Undiagnosed Celiac Disease', Gastroenterology, vol. 137, no. 1, pp. 88-93. https://doi.org/10.1053/j.gastro.2009.03.059
Rubio-Tapia A, Kyle RA, Kaplan EL, Johnson DR, Page W, Erdtmann F et al. Increased Prevalence and Mortality in Undiagnosed Celiac Disease. Gastroenterology. 2009 Jul;137(1):88-93. https://doi.org/10.1053/j.gastro.2009.03.059
Rubio-Tapia, Alberto ; Kyle, Robert A. ; Kaplan, Edward L. ; Johnson, Dwight R. ; Page, William ; Erdtmann, Frederick ; Brantner, Tricia L. ; Kim, W. Ray ; Phelps, Tara K. ; Lahr, Brian D. ; Zinsmeister, Alan R. ; Melton, L. Joseph ; Murray, Joseph A. / Increased Prevalence and Mortality in Undiagnosed Celiac Disease. In: Gastroenterology. 2009 ; Vol. 137, No. 1. pp. 88-93.
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abstract = "Background & Aims: The historical prevalence and long-term outcome of undiagnosed celiac disease (CD) are unknown. We investigated the long-term outcome of undiagnosed CD and whether the prevalence of undiagnosed CD has changed during the past 50 years. Methods: This study included 9133 healthy young adults at Warren Air Force Base (sera were collected between 1948 and 1954) and 12,768 gender-matched subjects from 2 recent cohorts from Olmsted County, Minnesota, with either similar years of birth (n = 5558) or age at sampling (n = 7210) to that of the Air Force cohort. Sera were tested for tissue transglutaminase and, if abnormal, for endomysial antibodies. Survival was measured during a follow-up period of 45 years in the Air Force cohort. The prevalence of undiagnosed CD between the Air Force cohort and recent cohorts was compared. Results: Of 9133 persons from the Air Force cohort, 14 (0.2{\%}) had undiagnosed CD. In this cohort, during 45 years of follow-up, all-cause mortality was greater in persons with undiagnosed CD than among those who were seronegative (hazard ratio = 3.9; 95{\%} confidence interval, 2.0-7.5; P < .001). Undiagnosed CD was found in 68 (0.9{\%}) persons with similar age at sampling and 46 (0.8{\%}) persons with similar years of birth. The rate of undiagnosed CD was 4.5-fold and 4-fold greater in the recent cohorts, respectively, than in the Air Force cohort (both P ≤ .0001). Conclusions: During 45 years of follow-up, undiagnosed CD was associated with a nearly 4-fold increased risk of death. The prevalence of undiagnosed CD seems to have increased dramatically in the United States during the past 50 years.",
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AU - Rubio-Tapia, Alberto

AU - Kyle, Robert A.

AU - Kaplan, Edward L.

AU - Johnson, Dwight R.

AU - Page, William

AU - Erdtmann, Frederick

AU - Brantner, Tricia L.

AU - Kim, W. Ray

AU - Phelps, Tara K.

AU - Lahr, Brian D.

AU - Zinsmeister, Alan R.

AU - Melton, L. Joseph

AU - Murray, Joseph A

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