Celiac.com 08/06/2012 - Celiac disease seems to be on the rise in the United States, with recent population-based data suggest a sharp increase in rates over the last several decades.

A number of researchers hypothesize that such a rise might be due in part to disease triggers including inter-current illnesses, such as gastroenteritis, surgeries, and trauma.

Photo: CC--Ed YourdonBut just how common is celiac disease among the healthy adult population, and what, if any, do prior illnesses have to do with it? To get a better idea of actual rates and connections, a team of researchers recently conducted a study regarding the incidence and risk of celiac disease in healthy U.S. adults.

The research team included Mark S. Riddle, Joseph A. Murray and Chad K. Porter. For their study, they turned to data from active duty US military personnel, a largely healthy population with excellent medical diagnostic coding. The data offered a unique opportunity to spot trends in celiac disease and deployment-related risk factors.

The team used electronic medical encounter data, from 1999–2008, on active duty US military personnel. In all, they reviewed data for over 13.7 million person-years, to conduct a matched, nested case–control study describing the epidemiology and risk determinants of CD (based on ≥2 ICD-9 medical encounters).

Using this data, they were able to estimate incidence and duration of celiac-related medical care, and to employ conditional logistic regression to evaluate celiac disease risk following infectious gastroenteritis (IGE) up to 3 years before celiac diagnosis, while controlling for other risk factors.

They found a total of 455 incident cases of celiac disease, which they then age, gender, and time matched to 1,820 control subjects.

They found that, from 1999 to 2008, cases of celiac disease increased five-fold from 1.3 per 100,000 to 6.5 per 100,000, with the highest rates of increase among those over 34 years of age. The average annual increase was 0.8 cases per 100,000.

They found a total of 172 episodes of IGE, 60.5% of which were viral in nature.

Using multivariate models, they found a strong association between IGE and CD was found (Odds ratio (OR): 2.06, 95% confidence interval (CI) 1.43, 2.97). Risk generally increased with temporal proximity to, and non-viral etiology of, exposure.

Other notable risk factors for CD in multivariate models were Caucasian race (OR: 3.1, P).

Rates of celiac disease in the US military are rising, particularly among those in the fourth and fifth decades of life and the rates seem higher than other population-based estimates.

The team noted a connection between prior IGE and risk of celiac disease, but they noted that they could not rule out possible IGE misclassification, and called for further study to better determine any links between pathogen-specific exposure to celiac disease, anti-gluten antibody development or symptom onset.

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