Trends in the identification and clinical features of celiac disease in a North American community, 1950–2001

doi:10.1053/jcgh.2003.50004

Clinical Gastroenterology and Hepatology

Volume 1, Issue 1, January 2003, Pages 19-27

https://doi.org/10.1053/jcgh.2003.50004 Get rights and content

Abstract

Background & Aims: Celiac disease is considered rare in North America. However, an increasing incidence and widening clinical spectrum have been reported in many countries, and serologic screening suggests a higher prevalence of minimally symptomatic disease. This study reports temporal trends in the incidence of celiac disease in Olmsted County, Minnesota. Methods: All county residents diagnosed with celiac disease between 1950 and 2001 were identified through the Rochester Epidemiology Project. Incidence rates were calculated assuming a Poisson distribution, and changes in incidence by calendar year, age, and gender were assessed by using Poisson regression. Results: Altogether, 82 new cases of celiac disease were identified during the 50-year period. There was a marked female predominance (P < 0.005), and the incidence rates increased with age (P < 0.001) and calendar period (P < 0.001). The overall annual incidence of celiac disease was 2.1 per 100,000 (95% confidence interval [CI], 1.7–2.6) but increased from 0.9 per 100,000 (CI, 0.5–1.2) in 1950–1989 to 3.3 per 100,000 (95% CI, 2.2–4.4) in the 1990s. The incidence was 9.1 per 100,000 (95% CI, 5.2–13.0) in the final 2 years of the study. Serology prompted biopsy in a substantial proportion of recent diagnoses. Clinical features also changed over time, with less diarrhea and weight loss at presentation. Conclusions: Celiac disease has increased recently in this well-characterized population. Milder clinical features and use of serology suggest an increased detection rate, although a true increase in incidence may have also occurred. Celiac disease is not rare in North America.

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2003;1:19-27

Section snippets

Study setting

Olmsted County, Minnesota, is a medically welldefined population in the upper Midwest. The population is largely white of Northern European extraction.¹³ Until recently, the population was almost entirely composed of whites of European extraction. In the last decade, there has been a recent influx of first Southeast Asian and then African ethnic groups so that the nonwhite group is about 10%. Population-based research is feasible in Olmsted County because medical care is virtually

Results

Eighty-two Olmsted County residents were diagnosed with biopsy-proven celiac disease between 1950 and 2001. There were substantially more females than males (58 vs. 24; P < 0.005). All patients were white of European extraction. There was a marked adult predominance (median age at diagnosis, 46 years; range, 1–84 years) (Figure 1).

. Incidence of celiac disease among Olmsted County, Minnesota, residents, 1950–2001, by age at diagnosis.

Less than 15% (12 of 82) of the patients were 18 years of age

Discussion

The incidence of celiac disease has been increasing in most European countries where it has been measured.12, 21, 22, 23 Consistent with these results, we have identified a dramatic increase, predominantly in the last decade, in this study from the upper Midwest of the United States. Our recent incidence rates are much greater than those reported previously.⁴ However, the recent incidence rates are equivalent to those for Crohn's disease and ulcerative colitis in the same population24, 25 and

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^☆: Address requests for reprints to: Joseph A. Murray, M.D., Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, SW, Rochester, Minnesota 55905. e-mail: [email protected]; fax: (507) 284-0538.

^☆☆: Supported in part by research grants DK 57982 (to J.A.M.) and AR 30582 (to L.J.M.) from the National Institutes of Health, US Public Health Service.

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Original ArticlesTrends in the identification and clinical features of celiac disease in a North American community, 1950–2001☆,☆☆

Abstract

Section snippets

Study setting

Results

Discussion

Gastroenterology

Am J Gastroenterol

Gastroenterology

Gastroenterology

Mayo Clinic Proc

Gastroenterology

Am J Med

Gastroenterology

Gastroenterology

Gastroenterology

Baillieres Clin Gastroenterol

Lancet

Celiac sprue

N Engl J Med

The highest incidence of celiac disease in Europe: the Swedish experience

J Pediatr Gastroenterol Nutr

Epidemiology of celiac sprue: a community-based study

Am J Gastroenterol

How many hospital visits does it take before celiac sprue is diagnosed?

J Clin Gastroenterol

The coeliac iceberg in Italy: a multicentre antigliadin antibodies screening for coeliac disease in school-age subjects

Acta Paediatr Suppl

American Gastroenterological Association medical position statement: celiac sprue

Gastroenterology

Incidence and presentation of coeliac disease in South Glamorgan

Eur J Gastroenterol Hepatol

High incidence and prevalence of adult coeliac disease: augmented diagnostic approach

Scand J Gastroenterol

United States Census Bureau Report

Revised criteria for diagnosis of coeliac disease: report of Working Group of European Society of Paediatric Gastroenterology and Nutrition

Arch Dis Child

The threat to medical-records research

N Engl J Med

Calculating incidence, prevalence and mortality rates for Olmsted County, Minnesota: an update

Generalized linear models

Original Articles
Trends in the identification and clinical features of celiac disease in a North American community, 1950–2001☆,☆☆