title: A large variety of clinical features and concomitant disorders in celiac disease - A cohort study in the Netherlands.
abstract: OBJECTIVE
  Celiac disease (CeD) is a gluten triggered, immune-mediated disease of the small intestine. Few clinical cohort descriptions are available, despite the diverse clinical picture. This study provides an overview of a large Dutch CeD cohort focusing on presenting symptoms, co-occurrence of immune mediated diseases (IMD) and malignancies.
  
  
  METHODS
  We performed a retrospective study in a Dutch university and a non-university medical hospital and included only biopsy proven (≥Marsh type 2 classification) CeD patients.
  
  
  RESULTS
  412 patients were included, selected from 9468 small-bowel biopsy pathology reports and financial codes. Classical symptoms were present in approximately one third of the cohort (diarrhea (37.4%), fatigue (35.0%), weight loss (31.6%), abdominal pain (33.3%)). Atypical symptoms as constipation (10.4%) and reflux (12.4%) were reported as well. 11.7% was diagnosed without reported symptoms. In 25.2% concomitant IMD occurred (most prevalent: type 1 diabetes mellitus (4.9%), microscopic colitis (4.9%), immune mediated-thyroid disease (4.1%)). CeD patients with a concomitant IMD were diagnosed at a significantly higher age compared to those without (P=0.002). Malignancies occurred in 53 cases (12.9%), including eight Enteropathy Associated T-cell Lymphomas.
  
  
  CONCLUSIONS
  This is the first study describing a CeD cohort in such detail in the Netherlands and highlights the clinical heterogeneity and importance of screening for concomitant diseases in CeD.
authors: Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
authors: Marleen
authors: M
authors: Spijkerman
authors: Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
authors: Ineke L
authors: IL
authors: Tan
authors: Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands.
authors: Jeroen J
authors: JJ
authors: Kolkman
authors: Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
authors: Sebo
authors: S
authors: Withoff
authors: Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
authors: Cisca
authors: C
authors: Wijmenga
authors: Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
authors: Marijn C
authors: MC
authors: Visschedijk
authors: Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands. Electronic address: r.k.weersma@umcg.nl.
authors: Rinse K
authors: RK
authors: Weersma
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000453:epidemiology*; D002446:Celiac Disease / Q000150:complications* / Q000453:epidemiology*; D046728:Colitis, Microscopic / Q000453:epidemiology*; D015897:Comorbidity; D003248:Constipation / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology; D003967:Diarrhea / Q000209:etiology; D058527:Enteropathy-Associated T-Cell Lymphoma / Q000453:epidemiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006111:Graves Disease / Q000453:epidemiology; D050031:Hashimoto Disease / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D015431:Weight Loss; D055815:Young Adult
keywords: Autoimmune diseases; Coeliac disease; Comorbidity