Prognosis of unrecognized coeliac disease as regards mortality: a population-based cohort study.
OBJECTIVE
Clinically diagnosed coeliac disease patients carry an increased risk of mortality. As coeliac disease is markedly underdiagnosed, we aimed to quantify the risk of mortality in subjects with unrecognized and thus untreated coeliac disease.


METHODS
Blood samples from 6,987 Finnish adults were drawn in 1978-80, and sera were tested for immunoglobulin A (IgA)-class tissue transglutaminase antibodies (Eu-tTG) in 2001. Positive sera were further analysed for endomysial (EMA) and tissue transglutaminase antibodies by another test (Celikey tTG). EMA- and Celikey tTG-positive cases were compared to negatives as regards mortality in up to 28 years of surveillance, yielding a total follow-up of 147,646 person years. Dates and causes of death were extracted from the nation-wide database.


RESULTS
Altogether 74 (1.1%) of the participants were EMA- and 204 (2.9%) Celikey tTG-positive. The age- and sex-adjusted relative risk of overall mortality was not increased in either EMA (0.78, 95% CI 0.52-1.18) or Celikey tTG (1.19, 95% CI 0.99-1.42) -positive subjects. However, antibody-positive cases evinced a tendency to die from lymphoma, stroke, and diseases of the respiratory system.


CONCLUSIONS
The prognosis of unrecognized coeliac disease was good as regards overall mortality, which does not support screening of asymptomatic coeliac disease cases.
Lohi
Sini
S
Paediatric Research Center, Medical School, University of Tampere, Tampere, Finland.
Mäki
Markku
M
Rissanen
Harri
H
Knekt
Paul
P
Reunanen
Antti
A
Kaukinen
Katri
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000097:blood; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005387:Finland; D006306:Health Surveys / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D012306:Risk; D011503:Transglutaminases / Q000097:blood* / Q000276:immunology
D000906:Antibodies; D011503:Transglutaminases