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
0-1.9 year
250 2-4.9 year
5-14.9 year years 200
150 000 person
100 ses per 100 50 Ca
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-ppghase CD screening
8 1993 19922005-2006 7 1991 1987-88 6 1989-90 ths
rr 1994 1985-86 5 2009-2010 per 1000 bi
ss 4 1995 1983-84 1997 Case 3 1996 2000 1999 1998 2001 1978-82 2 1973-77 2002 1
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 Exppgloring the Iceber g of Celiacs in Sweden
A multicenter study with a two-phase cross-sectional CD screening All 6th ggyrade children at five study sites Umeå Phase I: 2005-2006: 10 041 children born in 1993 Norrtälje Phase II: 2009-2010: Norrköping 8 000 children born in 1997 Växjö LdLund Results from phase I Phase I Phase II
898.9 per 10001 000
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)
PiPrevious screen ing 5.3 per 1000 (95% CI 2.5 – 9.7) Study protocols & Questionnaires Prevalence CD Diagnostics markers & biopsy Weight & height
Health & Genetics Quality of life
Screening Health diabetes type 2 Substudies economics
Autoimmunity Symptoms Rome III
Complience & effect Immunology gltluten free diet Gluten free diet intervention www.simsam.org.umu.se 1973-1990 1991-1997 1998 – 15 % 40 % 100 % (?) Göteborg Göteborg Nationell täckning Lund Lund Norrköping Norrköping Umeå Umeå Växjö Växjö Danderyd Huddinge Jönköping Linköping Skellefteå Uddevalla Uppsala Västerås Örebro The Swedish Epidemic
300
0-1.9 year
250 2-4.9 year
5-14.9 year years 200
150 000 person 100 ? ses per 100
aa 50 C
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 Cases per 100 000 person years Stockholm 21-25 East Middle Sweden 26-30 West Sweden Småland and the islands 31-35
36-40 South Sweden
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
10 / 1000 10 / 1000 3 / 1000 5 / 1000
6 / 1000 8 / 1000 56 / 1000
Carlsson A.K, et al. Pediatrics, 2001;107: 42-5 Fasano A, et al. Arch Intern Med, 2003;163: 286-92 Maki M, et al. N Engl J Med, 2003;348:2517-24 Dube C, et al. Gastroenterology, 2005;128: S57-67 Tommasini A, et al.Arch Dis Child, 2004;89:512-5 Rewers M, Gastroenterology, 2005;128:S47-51 Hariz MB, et al Eur J Gastroenterol Hepatol, 2007;19:687- Catassi C. et al The global village of coeliac disease, 2005 694 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 Number of celiac epidemic cohorts Prevalens 3% disease cases Children 1,5 million 14 – 26 years ~ 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
55 er capita) pp
50
Wheat (kg 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] COLLABORATORSTACK!
Anneli Ivarsson (PI) Marie-Louise Hammarström Annelie Carlsson Britta Halvarsson Lars Stenhammar Dan Holmberg Lars Danielsson Eckart Mummert Eva Karlsson Maria Emmelin OfSOlof Sandströ m Agneta Hörnell Lotta Högberg Cecilia Olsson Lotta Webb Curt Löfgren Solveig Hammarroth Lars Lindholm Olle Hernell Stig Wall Hans Stenlund Anna Myléus Marie Lindqvist Anna Rosén Katrina Nordyke Cathrine Astermark Fredrik Norström Ann-Catrin Andersson Carina Lagerqvist Gudrun Hellgren CtCatar ina Lun dlldell ÅSdtöÅsa Sundström Ethel Kautto Birgitta Isaksson Anna Eriksson Barbro Skog www.etics.se Anette Eriksson SWlthSusanne Walther www.preventdtcd.com Monica Roos Solveig Linghult Ruthgerd Larsson Barbro Larsson