High Incidence of Celiac Disease in a Long-term Study of Adolescents with Susceptibility Genotypes

Celiac.com 03/20/2017 - Researchers really do not have really good data on rates of celiac disease in the general population of children in the United States. A team of researchers recently set out to estimate the cumulative incidence of celiac disease in adolescents born in the Denver metropolitan area.

The research team included Edwin Liu, Fran Dong, MS, Anna E. Barón, PhD, Iman Taki, BS, Jill M. Norris, MPH, PhD, Brigitte I. Frohnert, MD, PhD, Edward J. Hoffenberg, MD, and Marian Rewers, MD, PhD.

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Their team collected data on HLA-DR, DQ genotypes of 31,766 infants, born from 1993 through 2004 at St. Joseph’s Hospital in Denver, from the Diabetes Autoimmunity Study in the Young. For up to 20 years, the researchers followed subjects with susceptibility genotypes for celiac disease and type 1 diabetes for development of tissue transglutaminase autoantibodies (tTGA).

The team was looking for patients who developed either celiac disease autoimmunity (CDA) or celiac disease, and they defined CDA as persistence of tTGA for at least 3 months or development of celiac disease. Marsh 2 or greater lesions in biopsies or persistent high levels of tTGA, indicated celiac disease.

For each genotype, the team assessed cumulative incidence of CDA and celiac disease. To estimate the cumulative incidence in the Denver general population, they weighted outcomes by each genotype, based on the frequency of each of these genotypes in the general population.

They found that, of 1.339 patients they studied, 66 developed CDA and met criteria for celiac disease, while 46 developed only CDA. Seropositivity for tTGA resolved spontaneously, without treatment, in 21 of the 46 patients with only CDA (46%). The team estimated the total incidence for CDA in the Denver general population at 5, 10, and 15 years of age was 2.4%, 4.3%, and 5.1% respectively; incidence values for celiac disease were 1.6%, 2.8%, and 3.1%, respectively.

This 20-year prospective study of 1.339 children with genetic risk factors for celiac disease showed the total incidence of CDA and celiac disease to be high within the first 10 years.

Although more than 5% of children may experience a period of CDA, that is, persistently high celiac autoantibodies, not all of them develop celiac disease or require gluten-free diets.

Sources:

• Gastroenterology.DOI: http://dx.doi.org/10.1053/j.gastro.2017.02.002
• gastrojournal.org