Clinical spectrum of Celiac Disease. A high frequency of concomitant diseases.

Spijkerman, M. (2014) Clinical spectrum of Celiac Disease. A high frequency of concomitant diseases. thesis, Medicine.

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Abstract

Background: Celiac Disease (CD) is a common, chronic immune-mediated disease in genetically susceptible people induced by dietary exposure to gluten. CD is characterized by a clinical heterogeneity with increased morbidity attributable to frequent concomitant disorders. Most data on celiac disease is derived from broad epidemiological studies or case series on a specific concomitant disease. There is very limited data on the clinical spectrum and associated diseases of CD of in depth analysis of celiac cohorts. Furthermore there is few data on CD in the Netherlands. Aim: to provide an overview of the clinical presentation of CD patients in a large Dutch cohort with a focus on presenting symptoms, co-occurrence of immune mediated disorders and malignancies. Methods: We performed a retrospective study in a university and non-university medical center. Patient identification was based on financial codes (DBC) and the national pathology database (PALGA) from Jan 2003 to Sept 2013. All records were screened and patients were only included if patients were over 18 years at time of checking patient records combined with a duodenal biopsy with a Marsh 2 classification or higher. Patients with alternative diagnosis for a Marsh lesion, a negative HLA outcome or too much missing data were excluded. Results: From the initial 9468 cases we included 412 patients in our study based on the criteria as mentioned above. Median age at diagnosis was 39.5 years. Men were diagnosed at a significant older age than women, median aged 47.8 years and 35.8 years, respectively. 83.2% of the patients had positive auto-antibodies. Patients presented with a range of symptoms, most prevalent were (recurrent) diarrhea (37.4%), anemia (36.1%), fatigue (35%), abdominal pain (33.3%) and weight loss (31.6%). Remarkably, constipation (10.4%) and pyrosis (10.2%) were also presented frequently. 104 (25.2%) patients had one or more immune-mediated disorders. Type 1 diabetes mellitus and microscopic colitis both occur in 20 (4.9%) patients. Immune-mediated thyroid diseases was found in 17 (4.1%) patients, the associated dermatitis herpetiformis was found in 13 (3.2%) patients. IBD was found in 6 (1.5%) patients. Malignancies occurred in 51 (12.4%) patients of which 8 (1.9%) patients had an Enteropathy Associated T-Cell Lymphoma (EATL). In addition, colorectal cancer and melanomas were both found in 7 (1.7%) patients and strikingly even one jejunal cancer, a rare type of malignancy, was found. Conclusions: This is the first study describing a CD cohort in such detail in the Netherlands, it shows CD is a very heterogeneous disease. It is noteworthy that only a third of classic symptoms, like anemia, diarrhea, fatigue and weight loss are presented in this cohort. A quarter had a co-occurrence of an immune-mediated disease, which is in accordance with the current literature (15-30%), in particular, type 1 diabetes, microscopic colitis and immune-mediated thyroid diseases are found. Additionally, in a high frequency (12.4%) of our patient a malignancy was found, in particular EATL. This shows the importance of screening and awareness of related diseases in CD patients.

Item Type:	Thesis (Thesis)
Supervisor name:	Weersma, Prof. dr. R.K. and Visschedijk, Drs. M.C.
Supervisor name:	Kolkman, Prof. dr. J.J. and Medical Spectrum Twente
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:41
Last Modified:	25 Jun 2020 10:41
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/265

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