Search

Summary: Background: The prevalence of coeliac disease doubled in Finland from 1980 to 2000. Aims: To investigate whether this increase is continuing and if there are specific patient‐related factors predicting the development of coeliac disease at a population level. Methods: We elicited comprehensive health data in the nationwide Health 2000 and Health 2011 surveys. Serum samples were taken for the measurement of tissue transglutaminase antibodies (TGA); subjects who were seropositive were tested for endomysial antibodies (EmA). Coeliac disease was defined either as a reported diagnosis or as positive TGA and EmA. The surveys comprised, respectively, 6379 and 4056 individuals, forming representative samples for 2,946,057 and 2,079,438 Finnish adults. Altogether 3254 individuals participating in both surveys comprised a prospective follow‐up cohort. Results: Prevalence of coeliac disease was 2.12% in 2000 and 2.40% in 2011 (p = 0.156). In the prospective cohort, 16 out of the 3254 (0.49%) subjects developed coeliac disease during follow‐up from 2000 to 2011, with an annual incidence rate of 45 per 100,000 persons. Positive TGA without EmA (OR: 133, 95% CI: 30.3–584), TGA values in the upper normal range (51.1, 16.0–163), and after adjusting for TGA, previous autoimmune co‐morbidity (8.39, 4.98–35.9) in 2000 increased the likelihood of subsequent coeliac disease. Conclusions: The nationwide prevalence of coeliac disease kept on rising from 2.12% in 2000 to 2.40% in 2011 in Finland. Positive TGA without EmA, TGA titres in the upper normal range and a pre‐existing autoimmune disease predisposed to coeliac disease during the 10‐year follow‐up. [ABSTRACT FROM AUTHOR]

Objective. The majority of patients with coeliac disease remain undetected world-wide. Finland has aimed at a high detection rate by training health personnel, and has advocated serologic screening for known coeliac disease risk groups. The purpose here was to assess whether this approach has been effective in clinical practice. Material and methods. The study was based on a prospective database of new coeliac patients aged 16 years or more, to whom the Social Insurance Institution had paid monthly compensation for the additional cost of maintaining a gluten-free diet since 2002. To obtain this compensation the diagnostic criteria for coeliac disease, including biopsy findings, had to be attested in a statement from a physician. The incidence and prevalence rates were calculated until the end of 2006. The total population aged 16 years or more was 4.31 million. Results. In 2004-06, a total of 5020 persons (64% female) receiving a new dietary grant were identified through the database. The mean annual incidence of proven coeliac disease was thus 39 per 100,000 individuals. Altogether, 23,553 persons received the dietary grant. This gives a nation-wide point prevalence of adult coeliac disease of 0.55% (0.70% F, 0.38% M). There was a regional variation from 33 to 49 per 100,000 in the annual incidence and from 0.41% to 0.72% in the prevalence of coeliac disease. Conclusions. To the best of our knowledge, these figures for proven coeliac disease are the highest reported. Increased alertness to the condition and active case finding has made this efficient diagnostics possible. [ABSTRACT FROM AUTHOR]

Objective. To compare the nutritional parameters of individuals with a previous diagnosis of coeliac disease (CD) with those of screen-detected patients in a large cohort of adults in primary care. Material andmethods. A cohort of 1900 adults (aged 18–64 years) was screened for tissue transglutaminase antibodies (TG2A) in primary care in the capital region of Finland. IgA-endomysium antibodies (EmA), HLADQ2/8 associated with CD were determined in positive individuals. Folate, iron, and transferrin receptor in sera were assessed in patients reporting a previous diagnosis of CD and patients positive for the above tests. Results. Twenty-two out of 1900 (1%) patients reported a previous diagnosis of CD (biopsy-based 16/22 cases; 6/22 cases diagnostic criteria unknown). Among the screen-detected cases with TG2A&nvge; the cut-off value, 14/32 cases were considered to have CD based on high levels of both TG2A and EmA, DQ2/8 genotype and/or biopsy results. The prevalence of CD was as high as 1:53 in the total study population (36/1900), and in women even 1:46 (2.2%). Nutritional deficiencies were rare among CD patients diagnosed earlier (low iron = 1; low folate n=1) but common among those who had an undiagnosed CD (low folate n=6; p<0.005; concomitant iron deficiency n=2). One-third of the screen-detected CD patients were obese. Screen-detected patients did not present more abdominal symptoms than those with no CD. Conclusions. CD is common, the proportion among women possibly being as high as 2.2%. Although the great majority of screen-detected patients do not present any gastrointestinal symptoms at primary care, nutritional deficiencies such as low folate levels and iron deficiency are common. [ABSTRACT FROM AUTHOR]