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. 2018 Apr 17;5(1):e000201.
doi: 10.1136/bmjgast-2018-000201. eCollection 2018.

Mortality in coeliac disease: a population-based cohort study from a single centre in Southern Derbyshire, UK

Geoffrey K T Holmes  1 , Andrew Muirhead  2
Affiliations

Mortality in coeliac disease: a population-based cohort study from a single centre in Southern Derbyshire, UK

Geoffrey K T Holmes et al. BMJ Open Gastroenterol. .

Abstract

Objective: With the advent of screening tests, it was hypothesised that milder cases of coeliac disease coming to diagnosis might have reduced risk of mortality. An earlier publication did not support this view. We have re-examined this issue employing a larger number of patients followed for a further 8 years.

Design: Patients with coeliac disease from Southern Derbyshire, UK, were followed prospectively from 1978 to 2014 and included those diagnosed by biopsy and serology. Causes of death were ascertained. Standardised mortality ratios were calculated for all deaths, cardiovascular disease, malignancy, accidents and suicides, respiratory and digestive disease. Ratios were calculated for individual causes. Analysis centred on the postdiagnosis period that included follow-up time beginning 2 years from the date of coeliac disease diagnosis to avoid ascertainment bias. Patients were stratified according to date of diagnosis to reflect increasing use of serological methods.

Results: All-cause mortality increase was 57%. Mortality in the serology era declined overall. Mortality from cardiovascular disease, specifically, decreased significantly over time. Death from respiratory disease significantly increased in the postdiagnosis period. The standardised mortality ratio for non-Hodgkin's lymphoma was 6.32, for pneumonia 2.58, for oesophageal cancer 2.80 and for liver disease 3.10. Survival in those who died after diagnosis increased by three times over the past three decades.

Conclusions: Serological testing has impacted on the risk of mortality in coeliac disease. There is an opportunity to improve survival by implementing vaccination programmes for pneumonia and more prompt, aggressive treatments for liver disease.

Keywords: coeliac disease; epidemiology; lymphoma.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Number of diagnoses of coeliac disease by year in Southern Derbyshire from 1978 to 2014.
Figure 2
Figure 2
Standardised mortality ratios for patients diagnosed with coeliac disease.
Figure 3
Figure 3
Trend in diagnosis of coeliac disease and association with mortality.
See this image and copyright information in PMC

References

    1. Grainge MJ, West J, Card TR, et al. . Causes of death in people with celiac disease spanning the pre- and post-serology era: a population-based cohort study from Derby, UK. Am J Gastroenterol 2011;106:933–9. doi:10.1038/ajg.2010.506 - DOI - PubMed
    1. Hill PG, Holmes GK. Coeliac disease: a biopsy is not always necessary for diagnosis. Aliment Pharmacol Ther 2008;27:572–7. doi:10.1111/j.1365-2036.2008.03609.x - DOI - PubMed
    1. : Breslow NE, Day NE, Statistical methods in cancer research. Vol II. The design and analysis of cohort studies (IARC scientific publication no. 82. Lyon, France: International Agency for Research on Cancer, 1987. - PubMed
    1. Holmes GKT, Muirhead A. Epidemiology of coeliac disease in a single centre in Southern Derbyshire 1958-2014. BMJ Open Gastroenterol 2017;4:e000137 doi:10.1136/bmjgast-2017-000137 - DOI - PMC - PubMed
    1. West J, Logan RF, Smith CJ, et al. . Malignancy and mortality in people with coeliac disease: population based cohort study. BMJ 2004;329:716–9. doi:10.1136/bmj.38169.486701.7C - DOI - PMC - PubMed

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