Citation

Holmes GKT, Muirhead A. BMJ Open Gastroenterol. 2018; 5(1).

Copyright

(Copyright © 2018, British Society of Gastroenterology, Publisher BMJ Publishing Group)

DOI

10.1136/bmjgast-2018-000201

PMID

unavailable

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. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Language: en

Keywords

adult; human; suicide; female; male; accident; epidemiology; incidence; survival rate; United Kingdom; cause of death; mortality; standardized mortality ratio; major clinical study; controlled study; serology; human tissue; priority journal; middle aged; follow up; cardiovascular disease; respiratory tract disease; cohort analysis; prospective study; gastrointestinal disease; lymphoma; pneumonia; disease duration; liver disease; Article; mortality risk; nonhodgkin lymphoma; population based case control study; esophagus cancer; celiac disease; malignant neoplasm; all cause mortality; coeliac disease; endomysium antibody; intestine biopsy; protein glutamine gamma glutamyltransferase antibody