Causes of Death in Patients With Celiac Disease in a Population-Based Swedish Cohort

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Abstract
CELIAC DISEASE is a disorder characterized by permanent intolerance to the protein gluten, which is contained in grains such as wheat, rye, or barley, and manifested by inflammation of the small intestine in genetically susceptible individuals. Typical symptoms include diarrhea and weight loss, but many patients, especially adults, have only mild or atypical symptoms. The widely accepted basis for the diagnosis of celiac disease is a biopsy to confirm the jejunal villous atrophy.1,2 The prevalence of celiac disease ranges from 0.1 celiac patient per 1000 live births in Denmark, Finland, Germany, Spain, New Zealand, and the United States to approximately 3 per 1000 live births in Ireland.3-5 In Sweden, a high prevalence of childhood-onset celiac disease has been noted, but it is unclear to what extent this pattern reflects changes in infant exposure to gliadin (eg, through early introduction of cereal drinks).3,6 The reported prevalence of the disease in the United States seems to be somewhat low in light of the genetic similarities and European ancestry of many white Americans. Since serologic screening tests, such as antigliadin and antiendomysium antibody assays, have become more widely available in the last decade, it now seems that celiac disease is widely underdiagnosed,7-10 including in the United States.11-16 Recent population-based screening studies in several European countries have shown that prevalence of celiac disease is much higher (eg, 2 to 10 patients per 1000 individuals) than previously reported,10,17-20 making celiac disease one of the most common genetically based human diseases.21,22