Abstract
Background
Coeliac disease is characterised by an increased mortality mostly due to its complications.
Aims
To study the risk of developing complications according to clinical presentation and
age at diagnosis, a combined retrospective–prospective longitudinal study was performed
in three Italian centres.
Methods
Incidence of complications and mortality rates were calculated using type and age
at diagnosis of coeliac disease, sex, and centre of diagnosis as predictors. Patients
referred after being found to suffer from coeliac disease elsewhere were excluded.
Results
Between 01/1999 and 06/2015, 2225 adult coeliac patients were directly diagnosed in
our centres. 17 of them developed a complication and 29 died. In patients older than
60 years at diagnosis of coeliac disease, the risk of complication is 18 times higher
than in patients diagnosed at 18–40 years and 9 times higher than in patients diagnosed
at 40–60 years. Classical presentation increases the risk of complications by 7 times
compared to non-classical presentation; in asymptomatic patients the risk of complication
is virtually absent.
Conclusions
The risk of developing complications in coeliac patients is linked to age at diagnosis
of coeliac disease and type of clinical presentation. Follow-up methods of coeliac
patients should be tailored according to these parameters.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mortality in celiac disease.Nat Rev Gastroenterol Hepatol. 2010; : 158-162
- Low incidence but poor prognosis of complicated coeliac disease: a retrospective multicentre study.Dig Liver Dis. 2014; 46: 227-230
- Presentation and long-term follow-up of refractory celiac disease: comparison of type I with type II.Gastroenterology. 2009; 136: 81-90
- Survival in refractory coeliac disease and enteropathy-associated T-cell lymphoma: retrospective evaluation of single-centre experience.Gut. 2007; 56: 1373-1378
- Clinical staging and survival in refractory celiac disease: a single center experience.Gastroenterology. 2009; 136: 99-107
- How I treat enteropathy-associated T-cell lymphoma.Blood. 2012; 119: 2458-2468
- Primary small-bowel malignancy in the UK and its association with coeliac disease.QJM. 2003; 96: 345-353
- Small bowel adenocarcinomas—existing evidence and evolving paradigms.Nat Rev Clin Oncol. 2013; 10: 534-544
- Incidence of lymphoproliferative disorders in patients with celiac disease.Am J Hematol. 2012; 87: 754-759
- Refractory sprue, coeliac disease, and enteropathy-associated T-cell lymphoma. French Coeliac Disease Study Group.Lancet. 2000; 356: 203-208
- Mortality in patients with coeliac disease and their relatives: a cohort study.Lancet. 2001; 358: 356-361
- Etiologies and predictors of diagnosis in nonresponsive celiac disease.Clin Gastroenterol Hepatol. 2007; 5: 445-450
- PROgnosticating COeliac patieNts SUrvivaL: the PROCONSUL score.PLoS One. 2014; 9e84163
- Human leukocyte antigen-DQ2 homozygosity and the development of refractory celiac disease and enteropathy associated T-cell lymphoma.Clin Gastroenterol Hepatol. 2006; 4: 315-319
- Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology.Gut. 2014; 63: 1210-1228
- American College of Gastroenterology. ACG clinical guidelines: diagnosis and management of celiac disease.Am J Gastroenterol. 2013; 108: 656-676
- The Oslo definitions for coeliac disease and related terms.Gut. 2013; 62: 43-52
- Optimal strategies to identify aberrant intra-epithelial lymphocytes in refractory coeliac disease.J Clin Immunol. 2014; 34: 828-835
- Malignancy in coeliac disease - effect of a gluten free diet.Gut. 1989; 30: 333-338
- Long-term care for patients with coeliac disease in the UK: a review of the literature and future directions.J Hum Nutr Diet. 2016; 29: 617-623
- Influence of HLA-DQ2 and DQ8 on severity in celiac disease.J Clin Gastroenterol. 2012; 46: 46-50
- A second duodenal biopsy is necessary in the follow-up of adult coeliac patients.Ann Med. 2014; 46: 430-433
- The changing clinical profile of celiac disease: a 15-year experience (1998-2012) in an Italian referral center.BMC Gastroenterol. 2014; 14: 194
- Long-term follow-up of celiac adults on gluten-free diet: prevalence and correlates of intestinal damage.Digestion. 2002; 66: 178-185
- Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: a population-based cohort study.Ann Intern Med. 2013; 159: 169-175
- Do different coeliac patients have different mortality rates?.Gut. 2015; 64: 1187-1188
Article info
Publication history
Published online: December 08, 2017
Accepted:
December 3,
2017
Received in revised form:
November 7,
2017
Received:
September 13,
2017
Identification
Copyright
© 2017 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.
