Risk of Morbidity in Contemporary Celiac Disease

Nina R Lewis; Geoffrey KT Holmes

Disclosures

Expert Rev Gastroenterol Hepatol. 2010;4(6):767-780. 

In This Article

Expert Commentary & Five-year View

It has been know for years that many disorders coexist with celiac disease and a number of complications may arise, but which of these occur other than by chance and the magnitude of the risks have been less clear. This is because studies have often been poorly designed and underpowered to provide reliable information. More recently, researchers have access to large databases such as the General Practice Research Database in the UK and the Swedish In-Patient Registry, and these have allowed more precise estimates of the risks of comorbidities to be ascertained. But even these are not without their drawbacks, and may still introduce an element of ascertainment bias. However, only large studies will reveal whether some of the rare comorbidities are associated with celiac disease rather than occurring just by chance. An added difficulty is that so many celiac patients are in the submerged portion of the celiac iceberg and therefore, undiagnosed, so that prevalence figures will only ever be an approximation for a given number of diagnosed cases at a specific time.

Nevertheless, studies employing these sources have advanced understanding and will help to inform opinion on the vexed questions of whether and which conditions merit screening.

Why patients with celiac disease should develop other comorbidities will continue to be explored, and studies center on the loss of intestinal barrier function, genetic predispositions and conditions that lead to gluten intolerance.

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