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Adult Coeliac Disease in Clinical Practice
Linköpings universitet, Institutionen för molekylär och klinisk medicin, Gastroenterologi och hepatologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Medicincentrum, Endokrin- och magtarmmedicinska kliniken.
2006 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Coeliac disease (CD) is considered to be the result of a complex interplay of intrinsic (genetic) factors and variable extrinsic (environmental) factors. The complex background of CD explains its wide spectrum of clinical manifestations. For a very long time CD was considered more or less a disease of childhood, which was extremely rare in adults. Nowadays we know that CD is one of the most common food intolerance disorders.

An epidemiological study of CD in a geographically defined area of Sweden (Paper1) showed a prevalence of 95.5/ 100 000 inhabitants. Among the associated diseases an especially high incidence of associated thyroid disease, 10.8% was observed.

In a fifteen-year cohort follow up study of all CD-patients residing in the counties of Örebro and Linköping (Paper 2) the total mortality was increased with 38% (SMR 1.38 95% C.I. 0.31-0.83). This was mainly explained by a 48% increased death rate in ischemic heart disease, significant in patients over 65 years (SMR 1.58 95% C.I. 1.00-2.06). However, there was a 47 % lower risk of all malignancies (SIR 0.53 95% C.I. 0.31-0.83).

A cohort of 22 consecutively biopsy-proven adult CD patients (Paper 3), were followed in respect of antibody titres from diagnosis and after 1, 3, 6, and 12 months on a gluten free diet (GFD). All antibody titres fell sharply within one month. Thus excluding a CD diagnosis serologically on a patient who has initiated a GFD by herself is not to recommend.

In another cohort with CD patients (Paper IV) who were diagnosed 8-12 years earlier recommended and who were recommended, the reliability of diet history, serological and biochemical markers to predict the appearance of the small intestinal mucosa were analysed (Paper IV). The history of a strict GFD gave a predictive value of 88% of a mucosa in remission. The values of serological tests (AGA, EmA and tTG) to predict a mucosa in remission were 93% for all.

In CD patients in remission gastro-intestinal symptoms were evaluated with the GSRS questionnaire. Subjects with CD reported significantly more GI-symptoms than a general population sample (p<0.01). This was particularly true for women with CD who scored worse than female controls .By contrast men with CD reported no more symptoms than male controls.

sted, utgiver, år, opplag, sider
Institutionen för molekylär och klinisk medicin , 2006.
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 954
Emneord [en]
Coeliaci, prevalence, anocicted deseases, serology symptoms, mortality, malignant diseases
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-7373ISBN: 91-85497-93-2 (tryckt)OAI: oai:DiVA.org:liu-7373DiVA, id: diva2:22391
Disputas
2006-09-22, Universitetsaulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 13:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2006-09-15 Laget: 2006-09-15 Sist oppdatert: 2012-03-22
Delarbeid
1. Adult coeliac disease within a defined area in Sweden: A study of prevalence and associated diseases
Åpne denne publikasjonen i ny fane eller vindu >>Adult coeliac disease within a defined area in Sweden: A study of prevalence and associated diseases
1988 (engelsk)Inngår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 23, nr 8, s. 1000-1004Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

An epidemiologic study of coeliac disease in a geographically defined area of Sweden showed that the prevalence was 95.5/105 inhabitants aged 15 years or more. The highest prevalence, 178/105 inhabitants, was found in the age group 65-74 years. The lowest prevalence, 39/105 inhabitants, was found in patients aged 15-24 years. Among the associated diseases an especially high incidence of associated thyroid disease was observed: thyrotoxicosis occurred in 5.0% and hypothyroidism in 5.8% of the patients.

Emneord
Coeliac disease, dermatitis herpetiformis, epidemiology, thyroid disease
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-13985 (URN)10.3109/00365528809090160 (DOI)
Tilgjengelig fra: 2006-09-15 Laget: 2006-09-15 Sist oppdatert: 2009-02-24
2. Ischemic heart disease, not malignancy, increases mortality in coeliac disease: A population based study
Åpne denne publikasjonen i ny fane eller vindu >>Ischemic heart disease, not malignancy, increases mortality in coeliac disease: A population based study
Vise andre…
2006 (engelsk)Artikkel i tidsskrift (Fagfellevurdert) Submitted
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-13986 (URN)
Tilgjengelig fra: 2006-09-15 Laget: 2006-09-15
3. Antibody levels in adult patients with coeliac disease during gluten free diet a rapid initial decrease of clinical importance
Åpne denne publikasjonen i ny fane eller vindu >>Antibody levels in adult patients with coeliac disease during gluten free diet a rapid initial decrease of clinical importance
Vise andre…
2004 (engelsk)Inngår i: Journal of Internal Medicine, ISSN 0954-6820, Vol. 256, nr 6, s. 519-524Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective. Analysis of antibodies against tissue transglutaminase (tTG) has been shown valuable in the diagnosis of coeliac disease (CD) but how quickly serum titres decrease after introduction of a gluten-free diet (GFD) is not known in adults. CD is a well-recognized disorder amongst the general population and many persons try a GFD for fairly vague symptoms before they seek medical advice. Therefore, it is important to determine the time that the serologic tests remain predictive of the disease after the introduction of a GFD.

Methods. Sera were taken from 22 consecutively biopsy-proven adult patients with CD in connection with the diagnostic biopsy. The patients were followed for 1 year and sera were taken after 1, 3, 6 and 12 months after start of a GFD. Sera were stored at −20 °C and analysed for IgA antibodies against gliadin, endomysium and two different commercial tTG assays based on recombinant human tTG (tTGrh) and guinea-pig liver (tTGgp).

Results. Twenty patients could be followed during GFD and all antibody titres fell sharply within 1 month after introduction of a GFD and continued to decline during the survey interval. Thirty days after beginning the diet only 58, 84, 74 and 53% of all patients had positive antibody levels of tTGrh, tTGgp, EmA and AGA respectively.

Conclusions. As the antibodies used to confirm the diagnosis of CD fall rapidly and continue to decline following the introduction of a GFD, it is important that health care providers carefully inquire about the possibility of self-prescribed diets before patients sought medical attention.

Emneord
antibody response, coeliac disease, diet
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-13987 (URN)10.1111/j.1365-2796.2004.01406.x (DOI)
Tilgjengelig fra: 2006-09-15 Laget: 2006-09-15 Sist oppdatert: 2009-08-19
4. Long-term follow up of patients with coeliac disease: Serological correlates of mucosal remission
Åpne denne publikasjonen i ny fane eller vindu >>Long-term follow up of patients with coeliac disease: Serological correlates of mucosal remission
Vise andre…
2006 (engelsk)Artikkel i tidsskrift (Fagfellevurdert) Submitted
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-13988 (URN)
Tilgjengelig fra: 2006-09-15 Laget: 2006-09-15
5. High rate of gastrointestinal symptoms in celiac patients living on a gluten free diet: controlled study
Åpne denne publikasjonen i ny fane eller vindu >>High rate of gastrointestinal symptoms in celiac patients living on a gluten free diet: controlled study
2003 (engelsk)Inngår i: American Journal of Gastroenterology, ISSN 0002-9270, Vol. 98, nr 9, s. 2023-2026Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objectives: The aim of this study was to determine the occurrence of GI symptoms in adults with celiac disease (CD) treated with a gluten-free diet for several years.

Methods: We studied a cohort of adults with CD (n = 51; 59% women) aged 45–64 yr and proved to be in remission after 8–12 yr of treatment. They were examined by the GI Symptom Rating Scale, which comprises five syndromes: indigestion, diarrhea, constipation, abdominal pain, and reflux. A general population sample (n = 182; 57% women) of same age served as controls.

Results: Subjects with CD reported significantly more GI symptoms than the general population sample, as assessed by the GI Symptom Rating Scale total score (p < 0.01). This was particularly true for women with CD who scored worse than female controls for all syndromes on the GI Symptom Rating Scale. By contrast, the men with CD reported no more symptoms than male controls. The women with CD showed generally more complaints than the men with CD did, notably within indigestion, constipation, and abdominal pain, corresponding to a 2-fold higher rate of GI symptoms (60%vs 29%; p < 0.04).

Conclusion: Adult CD patients on a gluten-free diet for several years experienced significantly more GI symptoms than the general population sample. This may have some of its origin in the composition of a gluten-free diet. The symptoms were more pronounced in the women. This may raise questions of an association with their subjective health status, which has been shown to be lower than in men with CD.

HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-13989 (URN)10.1111/j.1572-0241.2003.07632.x (DOI)
Merknad
Presented in part at the 10th International Symposium on Celiac Disease, Paris, France, June 2–5, 2002.Tilgjengelig fra: 2006-09-15 Laget: 2006-09-15 Sist oppdatert: 2009-08-19

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