Celiac disease incidence high in susceptible adolescents

Last Updated: 2017-02-15

By Reuters Staff

NEW YORK (Reuters Health) – More than 5% of individuals in the general population develop celiac disease autoimmunity by age 15, but not all will develop celiac disease, new research shows.

“In a 20-year prospective study of 1,339 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,” the authors report.

But, they add, “Although more than 5% of children may experience a period of CDA, not all develop celiac disease or require gluten-free diets.”

Dr. Edwin Liu of the University of Colorado School of Medicine and Children’s Hospital Colorado in Aurora and colleagues defined celiac disease autoimmunity (CDA) as either positive tissue transglutaminase antibodies (tTGA) on two consecutive blood draws at least three months apart, or a single positive tTGA test plus intestinal biopsy confirming celiac disease (CD). Celiac disease was defined as tTGA plus a Marsh 2 or 3 lesion on intestinal biopsy or CDA with high tTGA levels (>0.5) on at least two visits.

The HLA-DQ2 or DQ8 genotypes that confer increased CD risk occur in 40% of the general population, Dr. Liu and colleagues noted in a February 7 online report in Gastroenterology.

In a previous study of these 1,339 children with HLA-DR, DQ genotypes, 0.9% had developed CD by age 5 years. The current report is based on an additional 15 years of follow-up.

During 20 years of follow-up, 66 of the study participants developed CDA and met CD criteria, while 46 only developed CD. In 21 of the study participants with CDA only, tTGA seropositivity resolved without treatment (46%).

Among the five different types of at-risk genotypes studied, cumulative CDA incidence ranged from 9.8% to 35.7%, while CD incidence ranged from 6.1% to 36.4%.

Based on the population frequencies of the high-risk groups, the investigators estimated the general population’s cumulative incidence of CDA to be 2.4% at five years of age, 4.3% at 10 years, and 5.1% at 15 years. Estimated cumulative CD incidence was 1.6% at age 5, 2.8% at age 10, and 3.1% at age 15.

While this represents “a significant increase from historical estimates in the U.S.,” the authors note, “this assessment of rising incidence is consistent with recent studies using different approaches in North America and Europe.”

The research team concludes: “It seems likely that the majority of celiac autoimmunity develops in childhood, and mostly before age 10, which could inform future efforts for universal screening.”

Dr. Liu was not available for an interview by press time.

SOURCE: http://bit.ly/2lPXCvI

Gastroenterology 2017.