Clinical—Alimentary TractIncreased Prevalence and Mortality in Undiagnosed Celiac Disease
Section snippets
Subjects
We concurrently tested serum samples for CD antibodies in 3 cohorts (Table 1). The first cohort, the Warren Air Force Base (WAFB) cohort, was a large sample of healthy young men whose serum was collected from 1948 to 1954 and stored frozen as part of a series of studies and surveillance activities related to streptococcal infection.12, 13 The cohort was subsequently used successfully to study the prevalence and outcomes of hepatitis C infection. The repository and construction of the study
Demographic data
The cohort total was 9133 persons. Of 7950 whose date of birth was known, 7511 (94.5%) were <25 years old, 426 (5.4%) were 25–40 years old, and 13 (0.2%) were >40 years at sampling. Of 6676 persons whose gender was known, 6579 (98.6%) were men. Among 6465 persons whose ethnicity was known, 5774 (89.3%) were white, 668 (10.3%) were African American, and 23 (0.4%) were of another race.
Serologic data
Among 9133 persons tested, the tTGA titer was negative in 9090 (99.5%), weakly positive in 30 (0.4%), and
Discussion
This study yielded 2 major findings. First, undiagnosed CD was associated with a nearly 4-fold increased risk of death compared with subjects without serologic evidence of CD. Second, the prevalence of CD seems to have increased dramatically in the United States during the past 50 years.
These results are important because, by testing a unique collection of sera obtained from 1948 to 1954, we were able to study the long-term natural history of CD. Our results confirm recent data19 showing that
Acknowledgments
Portions of this manuscript have been published in abstract form: Gastroenterology 2008;134(Suppl 1):A-80–81.
The opinions and assertations herein are of the authors and not to be construed as reflecting the views or positions of the National Academies, the Institute of Medicine, or the National Research Council.
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This article has an accompanying continuing medical education activity on page 373. Learning Objective: Upon completion of this CME exercise, successful learners will be able to understand the potential impact of the changing prevalence of undiagnosed celiac disease in its potential effect on long-term outcome.
Conflicts of interest The authors disclose no conflicts.
Funding Supported in part by the National Institutes of Health (NIH) under Ruth L. Kirschstein National Research Service Award/Training Grant in Gastrointestinal Allergy and Immunology Research T32 AI07047 (A.R.-T.), NIH grants DK57892, DK070031, AR30582 (J.A.M.), DK61617 (W.R.K.), and CA62242 (R.A.K.), and the CTSA grant 1UL1RR024150-01 from the National Center for Research Resources.