title: Prevalence and Morbidity of Undiagnosed Celiac Disease From a Community-Based Study.
abstract: Little is known about the prevalence and burden of undiagnosed celiac disease in individuals younger than age 50. We determined the prevalence and morbidity of undiagnosed celiac disease in individuals younger than age 50 in a community.
  
  
  
  We tested sera from 31,255 residents of Olmsted County, Minnesota (<50 y), without a prior diagnosis of celiac disease assay using an assay for IgA against tissue transglutaminase; in subjects with positive test results, celiac disease was confirmed using an assay for endomysial IgA. We performed a nested case-control study to compare the proportion of comorbidities between undiagnosed cases of celiac disease and age- and sex-matched seronegative controls (1:2). Medical records were abstracted to identify potential comorbidities.
  
  
  
  We identified 338 of 30,425 adults with positive results from both serologic tests. Based on this finding, we estimated the prevalence of celiac disease to be 1.1% (95% confidence interval, 1.0%-1.2%); 8 of 830 children tested positive for IgA against tissue transglutaminase (1.0%; 95% confidence interval, 0.4%-1.9%). No typical symptoms or classic consequences of diagnosed celiac disease (diarrhea, anemia, or fracture) were associated with undiagnosed celiac disease. Undiagnosed celiac disease was associated with increased rates of hypothyroidism (odds ratio, 2.2; P < .01) and a lower than average cholesterol level (P = .03) and ferritin level (P = .01). During a median follow-up period of 6.3 years, the cumulative incidence of a subsequent diagnosis with celiac disease at 5 years after testing was 10.8% in persons with undiagnosed celiac disease vs 0.1% in seronegative persons (P < .01). Celiac disease status was not associated with overall survival.
  
  
  
  Based on serologic tests of a community population for celiac disease, we estimated the prevalence of undiagnosed celiac disease to be 1.1%. Undiagnosed celiac disease appeared to be clinically silent and remained undetected, but long-term outcomes have not been determined.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rok Seon
authors.initials: RS
authors.lastname: Choung
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Larson
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Shahryar
authors.initials: S
authors.lastname: Khaleghi
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rubio-Tapia
authors.affiliation: Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, Minnesota.
authors.forename: Inna G
authors.initials: IG
authors.lastname: Ovsyannikova
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: King
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Larson
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lahr
authors.affiliation: Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, Minnesota.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Poland
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Camilleri
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address: murray.joseph@mayo.edu.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Murray
mesh_terms: D000293:Adolescent; D000328:Adult; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D001327:Autoimmune Diseases / Q000453:epidemiology*; D016022:Case-Control Studies; D002446:Celiac Disease / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D002784:Cholesterol / Q000097:blood; D015897:Comorbidity; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D005293:Ferritins / Q000097:blood; D019204:GTP-Binding Proteins / Q000276:immunology; D006801:Humans; D007037:Hypothyroidism / Q000453:epidemiology*; D007070:Immunoglobulin A / Q000097:blood*; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015995:Prevalence; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D015996:Survival Rate; D011503:Transglutaminases / Q000276:immunology; D055815:Young Adult
chemical_list: D007070:Immunoglobulin A; D005293:Ferritins; D002784:Cholesterol; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
keywords: Autoimmune Disease; Epidemiology; Mortality; Small Intestine