ISG Summer Meeting 2016
Oral Prize - Second Prize
Patricia Dominguez Castro
The Changing Face of Coeliac Disease Presentation; a 55 Five Year Perspective in Ireland
By P. Dominguez Castro1, G. Harkin2, M. Hussey3, B. Christopher4, C. Kiat2, J. Liong Chin1, V. Trimble1, T. Martin5, D. McNamara3, P. MacMathuna5, B. Egan6, B. Ryan3, NP. Kennedy1, D. Kevans1, R. Farrell4, N. Mahmud1, V. Byrnes2, R. McManus1.
1Trinity Translational Medicine Institute & Department of Clinical Medicine, Trinity Centre for Health Science, St James's Hospital, Dublin 8, Republic of Ireland, 2Department of Clinical Medicine, University College Hospital Galway, Galway, Republic of Ireland, 3Department of Clinical Medicine, The Adelaide and Meath Hospital, Dublin 24, Republic of Ireland, 4Connolly Hospital Blanchardstown, Blancharsdtown, Dublin 15, Republic of Ireland, 5Gastrointestinal Unit, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Republic of Ireland, 6Department of Clinical Medicine, Mayo General Hospital, Castlebar, Co Mayo, republic of Ireland.
Coeliac disease (CD) is an immune-mediated enteropathy characterized by a highly heterogeneous clinical presentation and associated complications in genetically predisposed individuals. It is estimated that CD occurs both in adults and children at a rate of approximately 1% in most populations. In recent years, a change in the phenotypic presentation of CD, together with an increase in the median age of diagnosis has been reported. Few studies have addressed the clinical phenotype of CD in Ireland and those available consist of small cohorts with no information on the disease evolution over time.
Our aim is to explore the CD clinical phenotype and associated conditions and its evolution over a period of 55 years in a cohort (n=706) of CD patients diagnosed from 1960-2015.
Retrospective analysis of medical records to collect clinical, serology, histology and associated conditions data from a cohort of CD patients (n=706) (median age 56 years, range 18-91 years). The sample was divided into five groups based on their year of diagnosis (≤ 1985, 1986-1995, 1996-2005, 2006-2010 and ≥ 2011). The data collected was analysed using the whole sample and posteriorly compared between the five groups.
When considering the whole sample, most patients were diagnosed ≥18 years of age. Classical CD was the most common clinical presentation at diagnosis (54.4%), and thyroid disease the most prevalent associated immune-mediated comorbidity (19.5%). When considering those diagnosed in adulthood over the five time periods, the median age of diagnosis increased from 33.5 years before 1986 to between 44 and 50 years in later periods (p<0.001). A continuous gradual decrease in classical presentation mirrored by an increase in non-classical or subclinical presentation was observed over time (p=0.001). Malabsorption symptoms such as diarrhoea and weight loss became significantly less common during the 55 year period (p=0.031 and p=0.001 respectively). There were no significant differences in the female/male ratio over time (p=0.853). Associated thyroid disease decreased significantly during the study period (p=0.006).
CD clinical presentation at diagnosis in adulthood in our sample has become milder over the 55 year period. Associated thyroid disease prevalence has also significantly decreased during the study period.