Increasing prevalence of coeliac disease in Swedish children: influence of feeding recommendations, serological screening and small intestinal biopsy activity.
BACKGROUND
The prevalence of coeliac disease (CD) in Swedish children has attracted considerable interest over the past few decades, and especially the influence of feeding habits on the increased incidence. A national study has reported a trend towards a decrease in incidence after a change in infant feeding recommendations was introduced in 1996. The aim of this study was to evaluate, in a geographically defined area, the change in incidence with time and the influence of the introduction of antibody analysis.


METHODS
Cases of suspected paediatric CD between 1980 and 2003 were studied for prevalence, biopsy findings and antibody analyses.


RESULTS
A total of 2029 children were investigated by small intestinal biopsy, yielding 554 CD cases. The area initially showed the same trend as the national study, but the annual incidence rate is now increasing again. Median age at diagnosis has increased significantly since 1997 from less than 2 years of age to above 5 years. Cumulative incidence at 2 years of age is much higher for the birth cohorts 1983-96 than 1980-82 or 1997-2001. Diagnostic accuracy was significantly higher after the introduction of antigliadin (AGA) analysis, and especially after antiendomysium (EMA) analysis.


CONCLUSIONS
The incidence rate of CD in small children in our region has varied widely over the 24-year period observed. Feeding practice and methods of investigation have changed during this period. The annual incidence rate for the total child population in 2003 was almost equal to the peak value observed in 1994. There were no conclusive results on whether antibody analysis had an influence on diagnostic activity, but this seems to have increased diagnostic accuracy.
Laurin
P
P
Division of Paediatrics, Department of Molecular and Clinical Medicine, IMK, Linköpings Universitet, Sweden. pia.laurin@swipnet.se
Stenhammar
L
L
Fälth-Magnusson
K
K
D000293:Adolescent; D017677:Age Distribution; D001707:Biopsy, Needle; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004032:Diet; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008403:Mass Screening / Q000379:methods; D015995:Prevalence; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012698:Serologic Tests / Q000379:methods; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013548:Sweden / Q000453:epidemiology