Docent & Barnläkare. Institutionen för Folkhälsa och Klinisk Medicin Enheten för Epidemiologi och Global Hälsa Umeå universitet

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1 CELIAKI Var står vi idag? Anneli Ivarsson Docent & Barnläkare BARNVECKAN I JÖNKÖPING 2010 Institutionen för Folkhälsa och Klinisk Medicin Enheten för Epidemiologi och Global Hälsa Umeå universitet

2 The Swedish Epidemic 300 Ca ses per person years year year year Year of diagnosis Ivarsson A et al. Acta Paediatr. 2000;89: Olsson C, et al Pediatrics 2008;122:

3 Multifactorial aetiology Lifestyle CD Genes Gluten Ivarsson A, Myleus A, Wall S. Towards preventing celiac disease - an epidemiological approach. In: Fasano A, Troncone R, Branski D, eds. Pediatric and Adolescent Medicine. New Frontiers in Celiac Disease. Karger Publishers, Basel, Switzerland. 2008, pp

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5 A two-phase CD screening Cases s per 1000 bir rths Age (years) Ivarsson A, et al. Acta Paediatr. 2000;89: Olsson C, et al Pediatrics 2008;122: Screening

6 Exploring the Iceberg of Celiacs in Sweden A multicenter study with a two-phase cross-sectional CD screening All 6th grade children at five study sites Phase I: : children born in 1993 Phase II: : children born in 1997 Umeå Norrtälje Norrköping Växjö Lund

7 Results from phase I

8 Phase I Phase II per per Children born in 1993 Children born in 1997

9 An increase in prevalence over time Current screening 29 per 1000 (95% CI 25 33) Previous screening 5.3 per 1000 (95% CI )

10 Study protocols & Study protocols & Questionnaires

11 Diagnostics markers & biopsy Prevalence CD Weight & height Genetics Health & Quality of life Screening diabetes type 2 Substudies Health economics Symptoms Rome III Autoimmunity Complience & effect gluten free diet Gluten free diet intervention Immunology

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13 % 40 % 100 % (?) Göteborg Göteborg Nationell täckning Lund Norrköping Umeå Växjö Lund Norrköping Umeå Växjö Danderyd Huddinge Jönköping Linköping Skellefteå Uddevalla Uppsala Västerås Örebro

14 The Swedish Epidemic person years Ca ases per year year year? Year of diagnosis Ivarsson A et al. Acta Paediatr. 2000;89: Olsson C, et al Pediatrics 2008;122:

15 Regional variation in celiac disease incidence Olsson C, et al Pediatrics 2008;122:

16 Regional variation in celiac disease incidence Upper Norrland Middle Norrland North Middle Sweden Stockholm East Middle Sweden West Sweden Småland and the islands South Sweden Cases per person years Olsson C, et al Pediatrics 2008;122:

17 Regional variation - ETICS I 20 / 1000 (95% CI 12 27) 27 / 1000 (95% CI 16 40) 27 / 1000 (95% CI 17 38) 41 / 1000 (95% CI 29 53) 34 / 1000 (95% CI 28 40) Illustration by Erik Winbo

18 Prevalence of celiac disease 29 / / / / / / / / / / 1000 Carlsson A.K, et al. Pediatrics, 2001;107: 42-5 Maki M, et al. N Engl J Med, 2003;348: Tommasini A, et al.arch Dis Child, 2004;89:512-5 Hariz MB, et al Eur J Gastroenterol Hepatol, 2007;19: Fasano A, et al. Arch Intern Med, 2003;163: Dube C, et al. Gastroenterology, 2005;128: S57-67 Rewers M, Gastroenterology, 2005;128:S47-51 Catassi C. et al The global village of coeliac disease, 2005

19 Hur vanlig är celiaki? 1 per per 1000 (0.4%) 10 per 1000 (1.0%) 30 per 1000 (3.0%)

20 Clinical implications Classical symptoms Atypical symptoms Diffuse symptoms No symptoms Current age of the epidemic cohorts Prevalens 3% years Children 1,5 million Number of celiac disease cases ~ cases cases undiagnosed Myleus A, et al. J Pediatr Gastroenterol Nutr 2009;49:

21 Clinical implications all ages 0-13 years years >26 years Prevalens 2% Prevalens 3% Prevalens 0.5% Approximately celiacs in Sweden Ivarsson A, et al. J Int Med 1999;245:63-68 Olsson C, et al Pediatrics 2008;122: Myleus A, et al. J Pediatr Gastroenterol Nutr 2009;49:

22 2002

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24 Wheat consumption Wheat (kg per capita) Years period Adapted from [CCP:GR-RI/04/4]

25 TACK! COLLABORATORS Anneli Ivarsson (PI) Annelie Carlsson Lars Stenhammar Lars Danielsson Eva Karlsson Olof Sandström Lotta Högberg Lotta Webb Solveig Hammarroth Olle Hernell Anna Myléus Anna Rosén Katrina Nordyke Fredrik Norström Carina Lagerqvist Catarina Lundell Ethel Kautto Barbro Skog Susanne Walther Solveig Linghult Barbro Larsson Marie-Louise Hammarström Britta Halvarsson Dan Holmberg Eckart Mummert Maria Emmelin Agneta Hörnell Cecilia Olsson Curt Löfgren Lars Lindholm Stig Wall Hans Stenlund Marie Lindqvist Cathrine Astermark Ann-Catrin Andersson Gudrun Hellgren Åsa Sundström Birgitta Isaksson Anna Eriksson Anette Eriksson Monica Roos Ruthgerd Larsson

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