Diagnosis in children 6 to 10 is up, while in those 65 and older it is down, study presented at DDW finds
Amy Ratner, director of scientific affairs
The incidence rate of celiac disease has increased over the past two decades, largely driven by diagnosis of children from six to ten years old, according to a study based on Minnesota electronic health records and presented at Digestive Disease Week (DDW).
On the other hand, incidence in adults seems to have plateaued and is starting to tend downward, especially in adults aged 65 and older, said study author Imad Absah, MD, a pediatric gastroenterologist at the Mayo Clinic.
Incidence of celiac disease tallies how many people are newly diagnosed with celiac disease each year. Prevalence measures how many people have celiac disease in total.
DDW is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
Researchers from the Mayo Clinic reviewed electronic health records from the clinic and the Olmsted Medical Center from January 2000 to December 2021 that are part of the Rochester Epidemiological Project. They identified all patients diagnosed with celiac disease in that time period who resided in Olmsted County, where the two medical institutions are located.
The overall incidence rate was higher at the end of the study period compared to the beginning and peaked between 2009 and 2011, when the plateau for adults between 18 and 64 and the downward trend for older adults began.
The incidence rate for younger children, those 10 and under, is continuing to increase. The highest incidence of new cases was among children 6 to 10 years old. In children under 5 years of age, the incidence tripled over the study period. In children 11 to 17 years old, incidence seems to have plateaued after 2017.
Nearly 700 patients were identified as having been diagnosed with celiac disease over the study period. Adults were biopsy confirmed and children were biopsy confirmed until 2012 when children who did not have a biopsy but were diagnosed with blood test results high enough to meet diagnosis standards were also included. About 30 percent of those diagnosed during the study period were children.
There was no significant difference in incidence trends over the last two decades based on gender, although incidence among females has been consistently higher and was 64 percent of those diagnosed during the study period. The average age of those diagnosed was about 32, which is consistent with previous data.
Researchers compared the increase in testing for celiac disease in the study community from 1998 to 2014 and found that the plateau in incidence in adults occurred even as testing continued to increase.
The discrepancy of incidence trend between children and adults might be the result of a shift to earlier screening and diagnosis as parents are more willing to seek medical care for children than themselves at regular intervals and monitor their growth more often.
Alternatively, it could be based on something in the environment, the timing of which is affecting children even as it is losing its effect on older patients.
Study limitations include the fact that Olmsted County is more than 80 percent white, making results difficult to generalize to North America, which is much more diverse. Another limitation is that some people in Olmstead County may have gone on the gluten-free diet without a biopsy and others may have been missed because they do not have symptoms, neither of which would be included in the incidence numbers.
Studies presented at DDW are sometimes preliminary and give an early look at investigations that are likely to include more details as they progress toward publication in a peer reviewed journal. Studies selected to be presented at DDW go through a review process.
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