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UK Study: Mortality for Untreated Celiac Disease Same as General Population

Celiac.com 09/29/2011 - Results of various studies comparing mortality in undetected celiac disease compared with the general population have been contradictory. Some studies have suggested a fourfold increase in mortality compared with the general population, while others have found no increase at all.

A research team set out to clarify the matter by crafting a cohort study of Cambridge doctors that would establish all-cause and cause-specific mortality in undiagnosed celiac disease, identified by anti-endomysial antibody (EMA) positivity.

Photo: CC- jimmediaThe team included C. Canavan, R. F. Logan, K. T. Khaw, and J. West. They are variously affiliated with the Division of Epidemiology and Public Health at University of Nottingham in Nottingham, UK, with the NIHR Biomedical Research Unit of the Nottingham Digestive Diseases Centre at Nottingham University Hospital in Nottingham, UK, and with the Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.

For their study, the team chose their subjects from a general population aged 45-76 years in 1990.

They then tracked all deaths using the Office for National Statistics. They calculated mortality rates per 1000 person year, making adjustments for age, gender, smoking and socioeconomic group using multivariate Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (CI).

Results showed 117,914 patient years of follow-up from 7527 participants, with an average of 16.8 years.

Eighty-seven patients suffered from undetected celiac disease, their all-cause mortality rate was 9.4 per 1000 person years (95% CI 5.4-16.1) compared with 12.7 (95% CI 12.1-13.4) in EMA-negative participants.

The adjusted all-cause mortality hazard ratio was 0.98 (95% CI 0.57-1.69). Untreated celiac disease showed no increase in death due to cancer or circulatory diseases. Adjusted hazard ratios were 1.27 (95% CI 0.57-2.85) and 1.39 (95% CI 0.66-2.92) respectively.

The research team found no higher overall mortality in people older than 45 years with undetected coeliac disease compared with the general population. They also found no increase in deaths related to circulatory disease or cancer.

The team concludes that these results do not support routine screening people older than 45 years for celiac disease.

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2 Responses:

 
Researcher
Rating: ratingfullratingfullratingfullratingemptyratingempty Unrated
said this on
03 Oct 2011 6:24:48 AM PST
One wonders how the research team was able to accurately compare "people with undiagnosed celiac" (who were actually diagnosed with celiac, just diagnosed rather late in life) with the general population (significant portions of which may have had truly undiagnosed celiac).

It is unclear whether those with "undetected celiac" were symptomatic or not. Were they screened because of symptoms, or were all patients in the study screened?

Did those with "undetected celiac" actually have villi damage, or were they in the early stages of celiac disease? This is an important question; previously, it was thought that celiac was solely a childhood-onset disease, but we are now seeing more and more adult-onset cases of celiac, where there has NOT been a lifetime of intestinal and other damage--but a half a lifetime of damage can certainly follow adult-onset celiac.

There is also no mention of whether those whose celiac was discovered via the endomysial antibody screening actually changed their diet, nor whether that improved their health.

The only circulatory disease associated with celiac is Reynaud's Syndrome, which is considered mild in its primary form, not something that would cause death. Secondary Reynaud's is more serious, but that is because it appears concurrently with other, more serious autoimmune disorders. So why do these researchers feel that it is important that there was no increase in deaths from circulatory causes, when that has never been a concern with celiac disease?

The study concludes that there is no increased risk of cancer death amongst undiagnosed celiacs, but that is not necessarily in contradiction to previous studies. What is important to note, though, is that previous studies note a strong link to cancer OCCURRENCE. The death rate from cancer is uniformly high, whether a patient has celiac or not.

I would like to see Mr. Adams write an article that analyzes and compares these studies, their outcomes, and their possible flaws, rather than just summarizing the studies. I am certainly grateful that he wrote this particular article, and that it is posted here to inform us.

However, the study itself is useless.

 
Alice K
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said this on
04 Oct 2011 4:09:52 AM PST
Remarkable findings. Perhaps these untreated celiac patients did not have very strong allergic reactions, which would also account for their being untreated. Patients who have strong overt symptoms, but simply don't realize it's celiac and continue eating gluten, might not be so lucky and might still have higher mortality rates than the general population.




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