title: Trends in the identification and clinical features of celiac disease in a North American community, 1950-2001.
abstract: OBJECTIVE
  Celiac disease is considered rare in North America. However, an increasing incidence and widening clinical spectrum have been reported in many countries, and serologic screening suggests a higher prevalence of minimally symptomatic disease. This study reports temporal trends in the incidence of celiac disease in Olmsted County, Minnesota.
  
  
  METHODS
  All county residents diagnosed with celiac disease between 1950 and 2001 were identified through the Rochester Epidemiology Project. Incidence rates were calculated assuming a Poisson distribution, and changes in incidence by calendar year, age, and gender were assessed by using Poisson regression.
  
  
  RESULTS
  Altogether, 82 new cases of celiac disease were identified during the 50-year period. There was a marked female predominance (P < 0.005), and the incidence rates increased with age (P < 0.001) and calendar period (P < 0.001). The overall annual incidence of celiac disease was 2.1 per 100,000 (95% confidence interval [CI], 1.7-2.6) but increased from 0.9 per 100,000 (CI, 0.5-1.2) in 1950-1989 to 3.3 per 100,000 (95% CI, 2.2-4.4) in the 1990s. The incidence was 9.1 per 100,000 (95% CI, 5.2-13.0) in the final 2 years of the study. Serology prompted biopsy in a substantial proportion of recent diagnoses. Clinical features also changed over time, with less diarrhea and weight loss at presentation.
  
  
  CONCLUSIONS
  Celiac disease has increased recently in this well-characterized population. Milder clinical features and use of serology suggest an increased detection rate, although a true increase in incidence may have also occurred. Celiac disease is not rare in North America.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA. murray.joseph@mayo.edu
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Murray
authors.forename: Carol
authors.initials: C
authors.lastname: Van Dyke
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Plevak
authors.forename: Ross A
authors.initials: RA
authors.lastname: Dierkhising
authors.forename: Alan R
authors.initials: AR
authors.lastname: Zinsmeister
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003874:Dermatitis Herpetiformis / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology