The prevalence of celiac disease increases but the majority of the patients still remain undiagnosed

We have shown that the clinical prevalence of celiac disease in Finland is among the highest worldwide reaching 0.7%. However, screening studies indicate that the true prevalence is even higher and increases by age being 1.5% in children, 2% in adults and 2.7% in the elderly. Thus, the prevalence increases by age and new seroconversions may still occur during older ages. In addition, our results have shown that the prevalence of celiac disease has nearly doubled between the late 70s and beginning of the 20th century. One plausible explanation for these increasing prevalence figures is offered by the hygiene-hypothesis. In contrast, a simultaneous decrease in the incidence of dermatitis herpetiformis has been observed in 1990s. The decreasing incidence might be due to earlier diagnosis and treatment of celiac disease as there is evidence that celiac disease may progress to dermatitis herpetiformis if the adherence to the gluten-free diet is poor.

Our results indicate that the screen-detected celiac patients are not entirely asymptomatic, but they suffer from symptoms such as mild gastrointestinal symptoms or osteopenia. Although TG2 antibody positivity is associated with increased risk of hip fractures, the prognosis of unrecognized celiac disease in terms of overall mortality and malignancy is good. According to our studies, the screen-detected celiac patients adhere well to the gluten-free diet and during the diet their quality of life and bone mineral density reach that of the general population.

One of our goals is to evaluate future trends in celiac disease prevalence in general but also focusing different phenotypes of the disease. Moreover, we will investigate the natural history of unrecognized celiac disease.

Our selected publications:

Heikkilä K, Heliövaara M, Impivaara O, Kröger H, Knekt P, Rissanen H, Mäki M, Kaukinen K. Coeliac disease autoimminity and hip fracture risk: findings from a prospective cohort study. J Bone Miner Res 2015;30:630-6

Kurppa K, Paavola A, Collin P, Sievänen H, Laurila K, Huhtala H, Saavalainen P, Mäki M, Kaukinen K. Benefits of gluten-free diet for asymptomatic patients with serologic markers of celiac disease. Gastroenterology 2014;147:610-7.

Salmi TT, Hervonen K, Kautiainen H, Collin P, Reunala T. Prevalence and incidence of dermatitis herpetiformis: a 40-year prospective study from Finland. Br J Dermatol 2011;165:354-9.

Vilppula A, Kaukinen K, Luostarinen L, Krekelä I, Patrikainen H, Valve R, Laurila K, Mäki M, Collin P. Clinical benefit of gluten-free diet in screen-detected older celiac disease patients. BMC Gastroenterol 2011;11:136.

Lohi S, Mäki M, Montonen J, Knekt P, Pukkala E, Reunanen A, Kaukinen K. Malignancies in cases with screening-identified evidence of coeliac disease: a long-term population-based cohort study. Gut 2009;58:643-7.

Lohi S, Mäki M, Rissanen H, Knekt P, Reunanen A, Kaukinen K. Prognosis of unrecognized celiac disease as regards to mortality. Ann Med 2009;41:508-515.

Virta L, Kaukinen K, Collin P. The incidence and prevalence of diagnosed coeliac disease in Finland. Results of effective case finding in adults. Scand J Gastroenterol 2009;44;933-8

Vilppula A, Kaukinen K, Luostarinen L, Krekelä I, Patrikainen H, Valve R, Mäki M, Collin P. Increasing prevalence and high incidence of celiac disease in elderly people: a population-based study. BMC Gastroenterol 2009;9:49.

Lohi S, Mustalahti K, Kaukinen K, Laurila K, Collin P, Rissanen H, Lohi O, Bravi E, Gasparin M, Reunanen A, Mäki M. Increasing prevalence of coeliac disease over time. Alimentary Pharmacol Ther 2007;26:1217-25.

Viljamaa M, Collin P, Huhtala H, Sievänen H, Mäki M, Kaukinen K. Is celiac disease screening in risk groups justified? Fourteen year follow-up with a special focus on compliance and quality of life. Alimet Pharmacol Ther 2005;22:317-24