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 27 May 2018

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High incidence of celiac disease in adolescents with susceptibility genotypes

The latest issue of Gastroenterology examines the high incidence of celiac disease in a long-term study of adolescents with susceptibility genotypes.

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Little is known about the incidence of celiac disease in the general population of children in the United States. 

Dr Edwin Liu and colleagues from Colorado, USA estimated the cumulative incidence of celiac disease in adolescents born in the Denver metropolitan area.

The research 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. 

Subjects with susceptibility genotypes for celiac disease, and type 1 diabetes were followed up for up to 20 years for development of tissue transglutaminase autoantibodies. 

The team's outcomes included the development of celiac disease autoimmunity or celiac disease. 

Celiac disease autoimmunity was defined as persistence of tissue transglutaminase autoantibodies for at least 3 months or development of celiac disease. 

Celiac disease was defined based on detection of Marsh 2 or greater lesions in biopsy specimens or persistent high levels of tissue transglutaminase autoantibodies. 

For each genotype, the researchers determined the cumulative incidence of celiac disease autoimmunity, and celiac disease. 

To estimate the cumulative incidence in the Denver general population, outcomes by each genotype were weighted according to the frequency of each of these genotypes in the general population.

Of 1339 subjects followed up, the research team found that 66 developed celiac disease autoimmunity and met criteria for celiac disease, and 46 developed only celiac disease autoimmunity. 

The research team observed that seropositivity for tissue transglutaminase autoantibodies  resolved spontaneously, without treatment, in 46% of the subjects with only celiac disease autoimmunity. 

The researchers estimated that the cumulative incidence for celiac disease autoimmunity in the Denver general population at 5, 10, and 15 years of age was 2%, 4%, and 5%, respectively, and incidence values for celiac disease were 2%, 3%, and 3%, respectively.

Dr Liu's team comments, "In a 20-year prospective study of 1339 children with genetic risk factors for celiac disease, we found the cumulative incidence of celiac disease autoimmunity, and celiac disease to be high within the first 10 years."

"Although more than 5% of children may experience a period of celiac disease autoimmunity, not all children develop celiac disease or require gluten-free diets."

Gastroenterol 2017: 152(6): 1329–1336.e1 
27 April 2017

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