KI 2009

Mortality in celiac disease

Jonas F. Ludvigsson

Earlier studies

0

1

2

3

4

Collin Viljamaa West Logan Peters Corrao Solaym. Nielsen CottoneAnderss.Metzger

Celiac Disease Positive Serology

Biopsi

28

CD serology data from 8 university hospitals

Latent CD, Normal mucosa but positiv CD serology

Validation

Questionnaries:1. Gastroenterol.2. Pediatricians3. Pathologists

Interobserver reliability

Patient Chart Reviews

Linkage toCD serology data

Normal Borderline Villous atr.

Normal 74 (96%) 3 0 77

Borderline 12 22 (56%) 5 39

Villous atr. 2 18 190 (90%) 210

Total 88 43 195 326

Interobserver reliability

96%

4%1%

9-10/10 5-8/101-4/10 Never

Adults: 96%

N = 180100%

Children: 100%

N = 68

Biopsy prior to CD diagnosis

Villous atrophy is clinical CD in 95% of cases

95%

5%

CD Not CD

Is villous atrophy equal to CD?

79% of the validated individuals with VA and 64% of those with inflammation had documented gastrointestinal symptoms prior to biopsy.

88% of the validated individuals with VA had positive CD serology before their first biopsy.

Is villous atrophy equal to CD?

3,700 13,400

29,000

Overall mortality

HR 95% CI for HR p-value Number of

deaths

Reference 1.00 1.00 23,633

CD 1.39 (1.33-1.45) 5.42527 E-53 3,049

Inflammation 1.72 (1.64-1.79) 2.7082 E-130 2,967

Latent CD 1.35 (1.14-1.58) 0.00034 183

Subanalyses

Increased mortality:All age groups including children

No difference over calendar periodNo difference between males/females

Low absolute risks

The End