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  • Jefferson Adams
    Jefferson Adams

    What's the Celiac Risk for Close Relatives of People with the Disease?

    Reviewed and edited by a celiac disease expert.

    Celiac.com 11/18/2015 - Researchers have known for some time that first-degree relatives (FDRs) of celiac patients are at high risk for developing the disease, and that prevalence among them varies from 1.6 to 38%. However, not much is known about specific risk levels when the FDR is sister, brother, mother, father, son, or daughter of a celiac patient.

    Photo: CC- Wendell OaskayA team of researchers recently conducted a meta-analysis and calculated pooled prevalence of celiac disease among FDRs, second-degree relatives (SDRs), and specific relations with given celiac patients. The research team included P. Singh, S. Arora, S. Lal, T.A. Strand, G.K. Makharia. They are variously affiliated with the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Max Healthcare, Gurgaon, India; Medical Services Division, Innlandet Hospital Trust, Lillehammer, Norway; and the Department of Gastroenterology and Human Nutrition at the All India Institute of Medical Sciences, New Delhi, India.



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    The team searched 2,259 related medical articles, and found 54 articles relevant for their meta-analysis. They defined celiac disease diagnosis using standard biopsy and Marsh criteria. Analysis of their data group showed an overall celiac disease prevalence of 7.5% (95% confidence interval (CI) 6.3%, 8.8%) in 10,252 FDRs and 2.3% (95% CI 1.3%, 3.8%) in 642 SDRs.

    Pooled celiac disease rates were highest in siblings, at 8.9%, followed by offspring, at 7.9%, and parents, at 3.0%.

    A total of 8.4% of female FDRs showed rates of celiac disease compared to 5.2% male FDRs (P=0.047).

    Sisters and daughters of a primary patient had the highest risk of having celiac disease, at 1 in 7 and 1 in 8, respectively), compared to a risk of 1 in 13 in sons, 1 in 16 in brothers, 1 in 32 in mothers, and 1 in 33 in fathers.

    The data also revealed differences in the pooled prevalence of celiac disease in FDRs according to their geographic location.

    Average pooled rates of celiac disease among FDRs is 7.5%, but the actual rate for a given individual varies widely based on their relationship with the primary celiac patient, and is also influenced by gender and geographical location.

    Source:



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  • About Me

    Jefferson Adams

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.


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  • Related Articles

    Scott Adams
    Am J Gastroenterol. 2003 Feb;98(2):377-81
    Celiac.com 07/31/2003 - The findings of this new study are very significant for families of those with celiac disease. The results indicate that 17% of those related to two celiac disease-diagnosed siblings will also have the disease. Past studies have shown that around 10% of first-degree relatives of celiacs also have it, but this study is unique as it focuses on the increased risk for families where two siblings have the disease. This study further emphasizes the conclusions of past studies: If you have a relative with celiac disease--get tested, especially if it is a first-degree relative. - Scott Adams

    Abstract
    :
    "Prevalence of celiac disease among relatives of sib pairs with celiac disease in U.S. families
    Am J Gastroenterol. 2003 Feb;98(2):377-81
    Book L, Zone JJ, Neuhausen SL.
    Division of Pediatric Gastroenterology and Nutrition, Department of PediatricsUniversity of Utah, Salt Lake City, USA.
    OBJECTIVE: Celiac disease is a familial malabsorptive disorder with an estimated prevalence in first-degree relatives of 10-12%. The prevalence for first-degree and more distant relatives has not been determined in families where there are two affected first-degree relatives. The aim of our investigation was to estimate the prevalence and relative risk for celiac disease in relatives of two siblings diagnosed with celiac disease.
    METHODS: We ascertained sib pairs with celiac disease, and then identified all living first-degree relatives and available second-degree relatives to minimize ascertainment bias. We measured IgA endomysial antibodies, a highly specific and sensitive assay for celiac disease, in all subjects without a confirmed biopsy diagnosis. For those individuals with positive serologic tests, IgA tissue transglutaminase antibody tests and human leukocyte antigen DQA1 and DQB1 genotyping were performed for additional confirmation. Individuals with positive biopsy and/or serology were considered affected. We calculated the relative risk of being affected with celiac disease using the lambda® statistic.
    RESULTS: The prevalence of celiac disease in relatives of affected sib pairs was as follows: 21.3% (13/61) of siblings (lambda(S) = 53); 14.7% (10/68) of offspring (lambda(O) = 37); 17.2% (28/163) of first-degree relatives; 19.5% (16/82) of second-degree relatives; and 17.8% (52/292) of all relatives (lambda® = 44.5).
    CONCLUSIONS: In these families, we identified a sibling risk approximately double that found in previous reports, as well as significant risk for more distant relatives, probably because of sharing of a common gene. In families where at least two siblings have been diagnosed with celiac disease, relatives are at high risk for celiac disease. Screening should be considered for all family members.


    Scott Adams
    Scand J Gastroenterol. 2003 Jul;38(7):727-31.
    Effectiveness of the sorbitol H2 breath test in detecting histological damage among relatives of coeliacs.
    Tursi A, Brandimarte G, Giorgetti GM, Inchingolo celiac disease.
    Dept. of Emergency, L. Bonomo Hospital, Andria (BA), Italy.
    Celiac.com 08/07/2003 - An Italian study conducted by Dr. L. Bonomo and colleagues and published in the July 2003 edition of Scandinavian Journal of Gastroenterology concludes that A significant proportion of coeliacs may be missed if relatives are screened by serology only, while the efficacy of sorbitol H2-BT in screening relatives is confirmed. This study confirms that neither a breath test nor serology can replace intestinal biopsy, which remains the gold standard for the diagnosis of celiac disease, thus confirming the continued importance of performing biopsies for diagnosing celiac disease. The studys goal was to determine the diagnostic capabilities of serological tests (antigliadin (AGA), antiendomysium (EMA) and anti-tissue transglutaminase (anti-tTG)) and sorbitol H2 breath test (H2-BT) in the detection of celiac disease in first-degree relatives. The study screened 111 first-degree relatives of 37 celiac families using both test methods to determine candidates for small-bowel biopsy. First-degree relatives with abnormal test results underwent a small-bowel biopsy, as did those with negative serological and H2 breath test results who had clinical complaints or suspected that they may have celiac disease.
    The biopsy results were expressed using the Marsh classification system, and celiac disease was diagnosed in 49 of the 111 screened relatives of celiacs, or in 44.14%. A breakdown of the results is as follows: 5 showed Marsh IIIc, 8 Marsh IIIb, 16 Marsh IIIa, 13 Marsh II and 7 Marsh I lesions. 19 relatives showed the classical form of celiac disease, 20 showed the sub-clinical form, and 10 showed the silent form. The serological test results indicated an overall positivity of only 36.73%, with strong positive results only in those with severe intestinal damage and Marsh IIIb-c lesions. The sorbitol H2-BT breath test results showed an overall positivity of 83.67%, and showed strong positivity in patients with slight histological damage (Marsh I-IIIa).


    Jefferson Adams
    Celiac.com 02/20/2013 - Scientific evidence indicates that the risk of developing celiac disease cannot be explained solely by genetic factors. There is some evidence to support the idea that the season in which a child is born can influence the risk for developing celiac disease. It is known that babies born in summer months are likely to be weaned and introduced to gluten during winter, when viral infections are more frequent.
    A number of studies indicate that early viral infections can increase risk levels for celiac disease, however, earlier studies on birth season and celiac disease have been small, and their results have been contradictory.
    To better answer the question, a research team recently set out to conduct a more thorough study of the relationship between birth month and celiac disease.
    The research team included B. Lebwohl, P.H. Green, J.A. Murray, and J.F. Ludvigsson. The study was conducted through the Department of Paediatrics at Örebro University Hospital in Örebro, Sweden.
    To conduct the study, the team used biopsy reports from all 28 Swedish pathology departments to identify individuals with celiac disease, which they defined as small intestinal villous atrophy (n=29 096).
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    So, being born in the summer is associated with a slightly higher risk of later celiac disease (OR 1.06; 95% CI 1.03 to 1.08; p).
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    Source:
    Arch Dis Child. 2013 Jan;98(1):48-51. doi: 10.1136/archdischild-2012-302360.


    Jefferson Adams
    Celiac.com 07/27/2015 - First-degree relatives of individuals with celiac disease are at increased risk for this disorder, but little is known about their risk for other autoimmune diseases.
    A research team recently set out to assess the risk of non-celiac autoimmune disease in first-degree relatives and spouses of people with celiac disease.
    The research team included Louise Emilsson, Cisca Wijmenga, Joseph A. Murray, and Jonas F. Ludvigsson. They are variously affiliated with the Primary Care Research Unit, Vårdcentralen Värmlands Nysäter, Värmland County, Sweden, the Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Oslo, Norway, the Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, and with the Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
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    Through Swedish health care registries, the team identified all first-degree relatives (fathers, mothers, siblings, and offspring) and spouses of 84,648 individuals with celiac disease, and 430,942 control subjects. The team used Cox regression analysis to calculate hazard ratios (HRs) for non-celiac autoimmune disease, such as Crohn’s disease, type 1 diabetes mellitus, hypothyroidism, hyperthyroidism, psoriasis, rheumatoid arthritis, sarcoidosis, systemic lupus erythematosus, or ulcerative colitis, within these groups.
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    Source:
     Clinical Gastroenterology and Hepatology. DOI: http://dx.doi.org/10.1016/j.cgh.2015.01.026


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