Better Celiac Diagnosis Has No Impact On Death Rates

Celiac.com 03/02/2011 - New blood screening tests have improved rates of diagnosis for celiac disease in recent decades, but better diagnosis has not reduced celiac-associated deaths, according to a report by UK researchers in the American Journal of Gastroenterology.

After serologic tests became available, there was an approximate tenfold increase in the numbers of people being diagnosed with celiac disease. Intuitively, one would expect this increase in diagnosis to be followed by a decrease in celiac-related deaths. The idea being that earlier diagnosis means earlier treatment with gluten-free diet, and, ideally, less associated conditions and deaths.

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However, the newest study in this area shows evidence of any change in all-cause mortality among people with celiac disease. That means that even with better, earlier diagnosis, people with celiac disease are still dying at the same rates as before.

Researcher Dr. Matthew J. Grainge, of the University of Nottingham, told Reuters Health that his team "found that people with celiac disease have a 37% increase in all-cause mortality compared with the general population."

His team found that people diagnosed with celiac disease since 2000 have a similar mortality risk as those diagnosed earlier despite the introduction of serological tests, "which has probably resulted in milder cases being identified," Grainge said.

For their study, the research team reviewed data on 1092 celiac disease patients diagnosed from the late 1950s onward, and who had been followed for a minimum of two years.

The team examined outcomes from 1978 until death or through the end of 2006. All study subjects were diagnosed at a single center and the study covered both the pre- and post-serology era. The study covered more than 10,000 person years of follow-up,  and tallied a total of 142 deaths.

The study revealed a significantly increased all-cause standardized mortality ratio (SMR) of 1.37. This was higher for men (SMR, 1.86) than for women (SMR, 1.10). Study subjects had higher rates of death from cancer (SMR, 1.61) digestive (SMR, 2.19) and respiratory diseases (SMR, 1.57) compared to the general population. In all, there were 21 deaths from respiratory diseases, 11 of those from pneumonia.

According to the research team, this data supports current guidelines recommending pneumococcal vaccination for people with celiac disease.

In conclusion, the researchers note that the results may offer doctors "an opportunity to reduce mortality following pneumococcal infection by increasing the uptake of vaccination against this pathogen as vaccination rates are currently well below 50%."

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