Background: The prevalence of celiac disease (CD) in Swedish children has attracted considerable interest during the last decades, and especially the influence of feeding habits on the increased incidence. A national study has reporled a trend of decreasing incidence in the last years after a change in infant feeding recommendations in 1996.
Aim: To evaluate, on a geographically defined area, the changes of incidence over time and the influence of the introduction of antibody analysis.
Material: All children investigated for suspected CD during 1980-2001 in the county of Östergötland in southeast Sweden. The population of children <18 years is 89,679 (Jan 1, 2001).
Results: 1901 children were investigated with small intestinal biopsy, yielding 472 CD cases. The area initially describes the same trends as the national study, hut the annual incidence rate is now increasing again. Median age at diagnosis has increased markedly since 1997 from less than 2 years to above 5 years. Cumulalive incidence is much higher for the birth cohorts 83-96 than 80-82 or 97-00. More biopsies were performed per 1,000 children after the introduction of anti-gliadin antibodies (AGA), and less biopsies after the introduction of antiendomysium antibodies (EMA). Diagnostic accuracy was significantly higher after AGA, and especially after EMA introduction.
Conclusions: The incidence rate of CD in small children has shown a large variation over the 22 years observed. Both feeding practice and methods of investigation have changed during the period. Annual incidence rate for the total child population in 2001 approaches the peak value observed in 1994. Median age at first biopsy has rnore than doubled in the last years. There were no conclusive results on whether antibody analyses influenced the diagnostic activity, but they seemed to have increased the diagnostic accuracy.