OBJECTIVES The prevalence of celiac disease (CD) varies greatly, potentially because of incomplete ascertainment of cases and small study samples with limited statistical power. Previous reports indicate that the incidence of CD is increasing. We examined the prevalence of CD in a well-defined US county. METHODS Population-based study in Olmsted County, Minnesota, US. Using the infrastructure of the Rochester Epidemiology Project, medical, histopathology, and CD serology records were used to identify all new cases of CD in Olmsted County since 2000. Age- and sex-specific and adjusted (to the US white 2000 population) incidence rates for CD were estimated. Clinical presentation at diagnosis was also assessed. RESULTS Between 2000 and 2010, 249 individuals (157 female or 63%, median age 37.9 years) were diagnosed with CD in Olmsted County. The overall age- and sex-adjusted incidence of CD in the study period was 17.4 (95% confidence interval [CI] = 15.2–19.6) per 100,000 person-years, increasing from 11.1 (95% CI=6.8–15.5) in 2000–2001 to 17.3 (95% CI=13.3–21.3) in 2008–2010. The temporal trend in incidence rates was modeled as a two-slope pattern, with the incidence leveling off after 2004. Based on the two classic CD symptoms of diarrhea and weight loss, the relative frequency of classical CD among incident cases decreased over time between 2000 and 2010 (p=0.044). CONCLUSION The incidence of CD has continued to increase in the past decade in a North American population.

Celiac disease affects a highly variable portion of the small intestine starting at the duodenum. The extent of visible enteropathy does not explain differences in clinical presentation. Most subjects with visually detected villous atrophy showed a clinically significant improvement after gluten withdrawal.

Background & Aims Outcomes of undiagnosed celiac disease (CD) are unclear. We evaluated morbidity and mortality of undiagnosed CD in a population-based sample of individuals ≥50 years of age. Methods Stored sera from a population-based sample of 16,886 Olmsted County, Minnesota residents ≥50 years of age were tested for CD based on analysis of tissue transglutaminase (tTGA) and endomysial antibodies (EMA). A nested case-control study compared serologically defined subjects with CD to age- and sex-matched, sero-negative controls. Medical records were reviewed for comorbid conditions. Results We identified 129 (0.8%) subjects with undiagnosed CD in a cohort of 16,847 older adults. A total of 127 undiagnosed cases (49% male, median age 63.0 years) and 254 matched controls were included in a systematic evaluation for more than 100 potentially coexisting conditions. Subjects with undiagnosed CD had increased rates of osteoporosis and hypothyroidism, as well as lower body mass index and levels of cholesterol and ferritin. Overall survival was not associated with CD status. During a median follow-up period of 10.3 years after serum samples were collected, 20 cases but no controls were diagnosed with CD (15.2% Kaplan-Meier estimate at 10 years). Conclusions With the exception of reduced bone health, older adults with undiagnosed CD had limited comorbidity and no increase in mortality compared to controls. Some subjects were diagnosed with CD within a decade of serum collection, indicating that although most cases of undiagnosed CD are clinically silent, some result in symptoms. Undiagnosed CD can confer benefits and liabilities to older individuals.

Background-There is an elevated prevalence of celiac disease (CD) in family members (FMs) of celiac patients, but most prior studies have been done on selected populations. Aim: To determine the clinical, serological and genetic predictors of CD in FMs of a population-based cohort of index cases.