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Celiac.com 01/09/2014 - Not much is known about costs associated with celiac disease. A team of Israeli researchers recently studied the costs in patients diagnosed with celiac disease. The research team included A.D. Heymann, M. Leshno, R. Endevelt, and R. Shamir of the Medical Division at Maccabi Healthcare Services in Tel Aviv, Israel. They conducted a retrospective case control study covering the period 2003-2006 in a large Israeli Health Maintenance Organization with over two million members. Their study group included 1,754 patients with celiac disease and a control group of 15,040 non-celiac patients. They calculated costs individually for each member, and aggregated costs according to main cost-branches. They conducted a linear step wise regression with costs as the dependent variable and age, gender and the presence of celiac disease as the independent variables. They then compared costs for patients with celiac disease with costs for patients suffering from other chronic diseases. The team found that the total costs of celiac disease patients were significantly higher than those for the control group for hospital admission, medications, laboratory and imaging. The overall hospital admission rate of celiac patients was 7.98% as opposed to 7.1% for the control group (p = 0.06). However, compared with other chronic illnesses, the costs of patients with celiac disease were similar to those of patients with diabetes and hypertension. This study does conclude that celiac disease patients do use more medical services than the general population, at rates likely higher than previously thought. Source: Health Econ Rev. 2013 Nov 7;3(1):23. doi: 10.1186/2191-1991-3-23.

Celiac.com 03/01/2010 - Common autoimmune disorders often coexist in the same subjects, and to cluster in families. A research team recently set out to quantify the risk of diagnosis of coexisting autoimmune diseases in more than 3000 index cases with clinically proven Graves' disease or Hashimoto's thyroiditis. The research team included Kristien Boelaert, PhD, Paul R. Newbya, Matthew J. Simmonds, PhD, Roger L. Holder, Jacqueline D. Carr-Smith, Joanne M. Heward, PhD, Nilusha Manjia, Amit Allahabadia, MD, Mary Armitage, DM, Krishna V. Chatterjee, PhD, John H. Lazarus, MD, Simon H. Pearce, PhD, Bijay Vaidya, PhD, Stephen C. Gough, PhD, and Jayne A. Franklyn, PhD. To establish the prevalence of coexisting autoimmune disorders, the team conducted a cross-sectional multi-center study of 3286 Caucasian subjects from UK hospital thyroid clinics. 2791 of those had Graves' disease, 495 had Hashimoto's thyroiditis. The team used a comprehensive questionnaire to obtain complete personal and parental history for each subject, including information on common autoimmune disorders, and parental history of hyperthyroidism or hypothyroidism. The frequency of other autoimmune disorders was 9.67% for patients with Graves' disease and 14.3% for those with Hashimoto's thyroiditis index cases (P=.005). Rheumatoid arthritis was the most common coexisting autoimmune disorder, striking 3.15% of patients with Graves' disease, and 4.24% of Hashimoto's thyroiditis cases. However, both conditions carried substantially higher relative risks for nearly all other autoimmune diseases (>10 for pernicious anemia, systemic lupus erythematosus, Addison's disease, celiac disease, and vitiligo). Cases of Graves' disease showed relative “clustering” among index subjects with parental hyperthyroidism, while cases of Hashimoto's thyroiditis showed relative “clustering” among index subjects with parental hypothyroidism. Relative risks for most other coexisting autoimmune disorders were markedly increased among parents of index cases. This study is one of the largest so far to quantify the risk of diagnosis of coexisting autoimmune diseases among more than 3000 index cases with clinically proven Graves' disease or Hashimoto's thyroiditis. These results emphasize the the importance of screening for other autoimmune diagnoses when patients with autoimmune thyroid disease show new or nonspecific symptoms. Source: Am. J. Med. Volume 123, Issue 2, Pages 183.e1-183.e9 (February 2010)

Celiac.com 11/25/2008 - Celiac disease is one of the most under-diagnosed medical disorders, with 97% of all cases currently remaining undiagnosed. According to the National Institutes of Health, 3 million people in theUnited States with celiac disease, while only 140,000 have beendiagnosed. Celiac disease ismore than twice as common in people over 50 years of age. People with untreated celiac disease are at risk of developing anynumber of associated conditions, including gastrointestinal cancer atrates of 40 to 100 times those of the general population, in additionto osteoporosis, and a two-fold increase in the risk of fractures,including first-time hip fractures. Moreover, an unusually highpercentage of people with celiac disease suffer from the followingconditions: Anemia, Arthritis, Ataxia, Cancer—Non-Hodgkin’s Lymphoma, Cow's Milk Intolerance, Dermatitis, Diabetes-Type 1, Irritable Bowel Syndrome, Liver Disease, Migraine Headaches, Nerve Diseaseand/or Peripheral Neuropathy, Obesity, Osteoporosis,Osteomalacia/Low Bone Density, Pancreatic & Thyroid Disorders. According to a new study by doctors based in Sweden, people with celiac disease face a significantly higher risk of developing thyroid disorders, including hypothyroidism, hyperthyroidism and thyroiditis. The thyroid is a small, butterfly-shaped gland in the neck that creates the hormones that control human metabolism. People with under-active thyroid, called hypothyroidism, suffer symptoms such as fatigue, sensitivity to cold, dry skin and weight gain, while people with overactive thyroid, called hyperthyroidism, commonly suffer from symptoms such as excessive sweating, heat intolerance, and nervousness. However, mild cases of hypo- or hyperthyroidism commonly present no symptoms at all. Inflammation of the thyroid gland is called Thyroiditis. The research team, led by Dr. Peter Elfstrom at Orebro University Hospital, reviewed Swedish national health records covering the period from 1963 to 2003. The team compared rates of thyroid disease for 14,000 people with celiac disease against some 68,000 non-celiac control subjects matched for age and gender. The results showed that people with celiac disease are diagnosed with hypothyroidism more than four times as often as non-celiacs, with hyperthyroidism more than three times as often as non-celiacs, and with hyperthyroidism more than 3.6 times as often as non-celiacs. Moreover, the relationship works both ways: people with established hypothyroidism, hyperthyroidism and thyroiditis face much higher rates of celiac disease. These results held true even after the data were adjusted for potential confounders, including the presence of diabetes mellitus. The researchers theorize that the association between celiac disease and thyroid disease may be due to shared genetic or immunological traits. This is just the latest in a string of studies that drives home the importance of early testing for suspected celiac cases, as early discovery and treatment with a gluten free diet greatly reduces associated complications in celiac disease. Journal of Clinical Endocrinology and Metabolism, October 2008.

Celiac.com 03/23/2010 - Introducing gluten to a baby's diet during a period of infection does not increase the risk of the child developing celiac disease later on, according to a study by Swedish researchers. The team of researchers, led by Dr. Jonas F. Ludvigsson of Sweden's Karolinska Institute, used data from the population-based All Infants in Southeast Sweden study to search for independent associations of childhood infections with the risk of developing celiac disease. The team had parents chronicle their children's diet and infectious diseases in their first year of life, including breastfeeding start and stop dates, and dates the babies first ate gluten-containing foods. They enrolled a total of 9,408 children, and logged a total of 42,826 reports of infectious disease in the first year of life, including 4,003 episodes of gastroenteritis. Of 2,528 children who suffered infection at the time of gluten introduction, 18 developed celiac disease, while 26 of 6,880 children without infection developed celiac disease; for a total of 44 biopsy-proven cases of celiac disease after the children's first birthday (p = 0.035). 167 children suffered from gastroenteritis during gluten introduction, but just one child developed celiac disease, compared to 43 of 9,241 with no gastroenteritis during gluten introduction (p = ns). Once adjusted for age at gluten introduction, age at breastfeeding termination, and age at infection, the results showed no significant connection between infection or gastroenteritis at the time of gluten introduction and the later development of celiac disease. The team pointed out that they lack data on specific infection types, which limits the scope of their conclusions, and that further study is warranted. "We cannot rule out the possibility that specific pathogens constitute risk factors for celiac disease, because risk estimates for infection at the time of gluten introduction were of borderline significance," they said, noting that the study design precluded identification of subclinical infections. The added that "because celiac disease is increasingly diagnosed in adulthood, screening...and a longer follow-up period would be required for complete elucidation of the possible relationship between infections and [the development of] celiac disease." Source: Pediatrics 2010;125:e530-e536.

Celiac.com 01/03/2008 - It’s pretty well documented that HLA-DQ2 and HLA-DQ8 sereotypes are closely associated with celiac disease. Patients who test positive for both sereotypes are at much greater risk for developing celiac disease. Celiac disease is closely associated with the presence of HLA-DQ2 and HLA-DQ8, and has also been tied to variations in the MY09B gene on the 19th chromosome. Homozygosity is the condition of having two identical genes, of many possible combinations, on a single chromosome site. HLA-DQ2 homozygosity means that a person has inherited the HLA-DQ2 gene from both parents. In addition to having a much higher risk of developing celiac disease in general, people with HLA-DQ2 homozygosity have a much higher risk of developing refractory celiac disease type II, and enteropathy-associated T-cell lymphoma. Refractory celiac disease is a rare type of celiac disease in which a gluten-free diet fails to eliminate symptoms and to reverse celiac-associated damage. Eneteropathy-associated T-cell lymphoma is a type of cancer that often develops in people with advanced intestinal damage such as commonly found in celiac patients. A team of Dutch doctors recently set out to determine if the presence of the MY09B gene carries an elevated risk of refractory celiac disease type II, and enteropathy-associated T-cell lymphoma. The research team evaluated 62 people who were confirmed to have both refractory celiac disease type II and enteropathy-associated T-cell lymphoma. They also evaluated 421 people with simple celiac disease, along with a control group of 1624 people without celiac disease. The team conducted genotyping of MY09B along with molecular HLA-DQ2 typing on all of the patients. The tests showed that one nucleotide variation in MY09B was substantially different in the refractory celiac group than in either the simple celiac or the control group. The allele in question is known as the rs7259292 T allele, and the results of the tests showed that it occurs far more frequently in patients with refractory celiac and enteropathy-associated T-cell lymphoma than in either the control group or the group with simple celiac disease. In fact, the halpotype that carries the rs7253292 T allele occurs in 11% of the patients with refractory celiac disease type II, and enteropathy-associated T-cell lymphoma compared with just 2% of the control group and 3% or patients with regular celiac disease. Additionally, the results showed that patients who carry the MY09B rs7259292 allele or who showed HLA-DQ2 homozygosity faced similarly high risk levels for refractory celiac disease type II, and enteropathy-associated T-cell lymphoma compared to patients with simple celiac disease. The results did not show any connection or interaction between the MY09B rs7259292 allele and HLA-DQ homozygosity. Clinical Gastroenterology and Hepatology; 2007: 5(12): 1399-1405