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
The Swedish Epidemic 300 Ca ses per 100 000 person years 250 200 150 100 50 0-1.9 year 2-4.9 year 5-14.9 year 0 1975 1980 1985 1990 1995 2000 Year of diagnosis Ivarsson A et al. Acta Paediatr. 2000;89:165-71 Olsson C, et al Pediatrics 2008;122:528-534
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 198-209
A two-phase CD screening 8 7 1993 1992 2005-20062006 Cases s per 1000 bir rths 6 5 4 3 2 1 2002 2001 2000 1999 1998 1997 1996 1995 1994 1991 1989-90 2009-2010 1987-88 1985-8686 1983-84 1978-82 1973-77 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Age (years) Ivarsson A, et al. Acta Paediatr. 2000;89:165-71 Olsson C, et al Pediatrics 2008;122:528-534 Screening
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: 2005-2006: 10 041 children born in 1993 Phase II: 2009-2010: 8 000 children born in 1997 Umeå Norrtälje Norrköping Växjö Lund
Results from phase I
Phase I Phase II 89 8.9 per 1000 21 per 1 000 Children born in 1993 Children born in 1997
An increase in prevalence over time Current screening 29 per 1000 (95% CI 25 33) Previous screening 5.3 per 1000 (95% CI 2.5 9.7)
Study protocols & Study protocols & Questionnaires
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
www.simsam.org.umu.se
1973-1990 1991-1997 1998 15 % 40 % 100 % (?) Göteborg Göteborg Nationell täckning Lund Norrköping Umeå Växjö Lund Norrköping Umeå Växjö Danderyd Huddinge Jönköping Linköping Skellefteå Uddevalla Uppsala Västerås Örebro
The Swedish Epidemic 300 000 person years Ca ases per 100 250 200 150 100 50 0-1.9 year 2-4.9 year 5-14.9 year? 0 1975 1980 1985 1990 1995 2000 Year of diagnosis Ivarsson A et al. Acta Paediatr. 2000;89:165-71 Olsson C, et al Pediatrics 2008;122:528-534
Regional variation in celiac disease incidence Olsson C, et al Pediatrics 2008;122:528-534
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 100 000 person years 21-2525 26-30 31-35 36-40 Olsson C, et al Pediatrics 2008;122:528-534
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 www.winboartstudio.com
Prevalence of celiac disease 29 / 1000 10 / 1000 3 / 1000 3 / 1000 10 / 1000 5 / 1000 10 / 1000 6 / 1000 56 / 1000 8 / 1000 Carlsson A.K, et al. Pediatrics, 2001;107: 42-5 Maki M, et al. N Engl J Med, 2003;348:2517-24 Tommasini A, et al.arch Dis Child, 2004;89:512-5 Hariz MB, et al Eur J Gastroenterol Hepatol, 2007;19:687-694 Fasano A, et al. Arch Intern Med, 2003;163: 286-92 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
Hur vanlig är celiaki? 1 per 1000 4 per 1000 (0.4%) 10 per 1000 (1.0%) 30 per 1000 (3.0%)
Clinical implications Classical symptoms Atypical symptoms Diffuse symptoms No symptoms Current age of the epidemic cohorts Prevalens 3% 14 26 years Children 1,5 million Number of celiac disease cases ~ 45 000 cases 30 000 cases undiagnosed Myleus A, et al. J Pediatr Gastroenterol Nutr 2009;49:170-176
Clinical implications all ages 0-13 years 14-26 years >26 years Prevalens 2% Prevalens 3% Prevalens 0.5% Approximately 100 000 celiacs in Sweden Ivarsson A, et al. J Int Med 1999;245:63-68 Olsson C, et al Pediatrics 2008;122:528-534 Myleus A, et al. J Pediatr Gastroenterol Nutr 2009;49:170-176
2002
Wheat consumption 70 65 60 Wheat (kg per capita) 55 50 45 40 1850 1890 1930 1970 1970 1975 1980 1985 1990 1995 2000 2005 Years period Adapted from www.fao.org [CCP:GR-RI/04/4]
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 www.etics.se www.preventcd.com 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