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Small-intestinal histopathology and mortality risk in celiac disease.

Abstract

CONTEXT

Studies of mortality in celiac disease have not taken small-intestinal pathology into account.

OBJECTIVE

To examine mortality in celiac disease according to small-intestinal histopathology.

DESIGN, SETTING, AND PATIENTS

Retrospective cohort study. We collected data from duodenal/jejunal biopsies taken between July 1969 and February 2008 on celiac disease (Marsh stage 3: villous atrophy; n = 29,096 individuals) and inflammation (Marsh stage 1-2; n = 13,306) from all 28 pathology departments in Sweden. A third cohort consisted of individuals with latent celiac disease from 8 university hospitals (n = 3719). Latent celiac disease was defined as positive celiac disease serology in individuals with normal mucosa (Marsh stage 0). Through linkage with the Swedish Total Population Register, we estimated the risk of death through August 31, 2008, compared with age- and sex-matched controls from the general population.

MAIN OUTCOME MEASURE

All-cause mortality.

RESULTS

There were 3049 deaths among patients with celiac disease, 2967 with inflammation, and 183 with latent celiac disease. We found an increased hazard ratio (HR) for death in celiac disease (HR, 1.39; 95% confidence interval [CI], 1.33-1.45; median follow-up, 8.8 years), inflammation (HR, 1.72; 95% CI, 1.64-1.79; median follow-up, 7.2 years), and latent celiac disease (HR, 1.35; 95% CI, 1.14-1.58; median follow-up, 6.7 years). The absolute mortality rate was 10.4 (95% CI, 10.0-10.8) per 1000 person-years in celiac disease, 25.9 (95% CI, 25.0-26.8) in inflammation, and 6.7 (95% CI, 5.7-7.6) in latent celiac disease. Excess mortality was 2.9 per 1000 person-years in celiac disease, 10.8 in inflammation, and 1.7 in latent celiac disease. This risk increase was also seen in children. Excluding the first year of follow-up, HRs decreased somewhat.

CONCLUSION

Risk of death among patients with celiac disease, inflammation, or latent celiac disease is modestly increased.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Pediatrics, Orebro University Hospital, Orebro 70185, Sweden. jonasludvigsson@yahoo.com

    , , ,

    Source

    JAMA 302:11 2009 Sep 16 pg 1171-8

    MeSH

    Adolescent
    Adult
    Antibodies
    Cause of Death
    Celiac Disease
    Child
    Child, Preschool
    Female
    Gliadin
    Humans
    Infant
    Inflammation
    Intestine, Small
    Male
    Middle Aged
    Proportional Hazards Models
    Retrospective Studies
    Risk
    Serologic Tests
    Sweden
    Transglutaminases
    Young Adult

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    19755695

    Citation

    Ludvigsson, Jonas F., et al. "Small-intestinal Histopathology and Mortality Risk in Celiac Disease." JAMA, vol. 302, no. 11, 2009, pp. 1171-8.
    Ludvigsson JF, Montgomery SM, Ekbom A, et al. Small-intestinal histopathology and mortality risk in celiac disease. JAMA. 2009;302(11):1171-8.
    Ludvigsson, J. F., Montgomery, S. M., Ekbom, A., Brandt, L., & Granath, F. (2009). Small-intestinal histopathology and mortality risk in celiac disease. JAMA, 302(11), pp. 1171-8. doi:10.1001/jama.2009.1320.
    Ludvigsson JF, et al. Small-intestinal Histopathology and Mortality Risk in Celiac Disease. JAMA. 2009 Sep 16;302(11):1171-8. PubMed PMID: 19755695.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Small-intestinal histopathology and mortality risk in celiac disease. AU - Ludvigsson,Jonas F, AU - Montgomery,Scott M, AU - Ekbom,Anders, AU - Brandt,Lena, AU - Granath,Fredrik, PY - 2009/9/17/entrez PY - 2009/9/17/pubmed PY - 2009/9/23/medline SP - 1171 EP - 8 JF - JAMA JO - JAMA VL - 302 IS - 11 N2 - CONTEXT: Studies of mortality in celiac disease have not taken small-intestinal pathology into account. OBJECTIVE: To examine mortality in celiac disease according to small-intestinal histopathology. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study. We collected data from duodenal/jejunal biopsies taken between July 1969 and February 2008 on celiac disease (Marsh stage 3: villous atrophy; n = 29,096 individuals) and inflammation (Marsh stage 1-2; n = 13,306) from all 28 pathology departments in Sweden. A third cohort consisted of individuals with latent celiac disease from 8 university hospitals (n = 3719). Latent celiac disease was defined as positive celiac disease serology in individuals with normal mucosa (Marsh stage 0). Through linkage with the Swedish Total Population Register, we estimated the risk of death through August 31, 2008, compared with age- and sex-matched controls from the general population. MAIN OUTCOME MEASURE: All-cause mortality. RESULTS: There were 3049 deaths among patients with celiac disease, 2967 with inflammation, and 183 with latent celiac disease. We found an increased hazard ratio (HR) for death in celiac disease (HR, 1.39; 95% confidence interval [CI], 1.33-1.45; median follow-up, 8.8 years), inflammation (HR, 1.72; 95% CI, 1.64-1.79; median follow-up, 7.2 years), and latent celiac disease (HR, 1.35; 95% CI, 1.14-1.58; median follow-up, 6.7 years). The absolute mortality rate was 10.4 (95% CI, 10.0-10.8) per 1000 person-years in celiac disease, 25.9 (95% CI, 25.0-26.8) in inflammation, and 6.7 (95% CI, 5.7-7.6) in latent celiac disease. Excess mortality was 2.9 per 1000 person-years in celiac disease, 10.8 in inflammation, and 1.7 in latent celiac disease. This risk increase was also seen in children. Excluding the first year of follow-up, HRs decreased somewhat. CONCLUSION: Risk of death among patients with celiac disease, inflammation, or latent celiac disease is modestly increased. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/19755695/Small_intestinal_histopathology_and_mortality_risk_in_celiac_disease_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2009.1320 DB - PRIME DP - Unbound Medicine ER -