Celiac disease is an increasingly common disease that may affect as many as 1% of the North American population.
Recent population-based data suggest a substantial increase in the prevalence of celiac disease over the last several decades.
Several factors are hypothesized as possible disease triggers including intercurrent illnesses, such as gastroenteritis, surgeries, and trauma.
Dr Mark Riddle and colleagues from Maryland, USA used the active duty US military, a unique healthy worker population with essentially complete medical diagnostic coding, as an opportunity to describe trends in celiac disease and deployment-related risk factors.
Using electronic medical encounter data on active duty US military, a matched, nested case–control study describing the epidemiology and risk determinants of celiac disease was conducted.
|The incidence of celiac disease increased 5-fold |
|American Journal of Gastroenterology|
Incidence and duration of celiac disease-related medical care were estimated.
The research team utilized conditional logistic regression to evaluate celiac disease risk following infectious gastroenteritis occurring within 3 years before celiac disease diagnosis while controlling for other risk factors.
A total of 455 incident cases of celiac disease were identified and age, gender, and time matched to 1820 controls.
The incidence of celiac disease increased 5-fold from 1 per 100,000 in 1999 to about 7 per 100,000 in 2008, with the highest rates of increase among those over 34 years of age.
A total of 172 infectious gastroenteritis episodes, predominately of “viral etiology”, were documented.
In multivariate models, a significant association between IGE and celiac disease was found.
The researchers found that risk generally increased with temporal proximity to, and non-viral etiology of, exposure. Other notable risk factors for celiac disease in multivariate models were Caucasian race, non-Army service, and greater than a high-school education.
Dr Riddle's team concludes, "Incidence of celiac disease diagnosis in the US military is increasing, particularly among those in the fourth and fifth decades of life and appears higher than other population-based estimates."
"An association between antecedent infectious gastroenteritis and risk of celiac disease was noted, but the potential for exposure misclassification cannot be ruled out."
"Further study is needed to link pathogen-specific exposure to incident celiac diseaase anti-gluten antibody development or symptom onset."