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QJM Advance Access published online on June 14, 2006
QJM, doi:10.1093/qjmed/hcl061
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© The Author 2006. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: Journals.permissions@oxfordjournals.org
Received December 19, 2005
Accepted March 24, 2006

Original Papers

The epidemiology of coeliac disease in East Dorset 1993-2002: An assessment of the ‘coeliac iceberg’, and preliminary evidence of case clustering

A.J. Fowell 1 *, P.W. Thomas 2, S.L. Surgenor 3, and J.A. Snook 3

1 From the Division of Infection, Inflammation and Repair, University of Southampton, Southampton General Hospital, Southampton, UK
2 From the Dorset Research and Development Support Unit, Poole Hospital, Poole, UK
3 From the Department of Gastroenterology, Poole Hospital, Poole, UK

* To whom correspondence should be addressed.
A.J. Fowell, E-mail: afowell{at}hotmail.com


  Abstract

Background: Coeliac disease (CD) results from mucosal exposure to dietary gluten in genetically predisposed individuals, although other environmental factors may be involved. The seroprevalence of CD is approximately 1%, with a high ratio of undiagnosed to diagnosed cases, leading to the concept of a ‘coeliac iceberg’.

Aim: To provide contemporary estimates of the incidence of diagnosed CD and the size of the submerged ‘coeliac iceberg’, and to seek evidence of disease clustering.

Design: Prospective observational study in a defined local population.

Methods: Data were collected prospectively for all biopsy-proven cases diagnosed at Poole Hospital, 1993-2002. Age-specific incidence was calculated and point prevalence estimated for cases within the defined study zone. Evidence of disease clustering was sought using a space-time scan statistic based on a Poisson model.

Results: The overall incidence of CD was 8.7 cases/100 000/year (95%CI 7.4-10.1), with a median age at diagnosis of 53 years. Incidence increased progressively during the study period, and the estimated point prevalence of biopsy-proven CD rose from 0.18% to 0.4%. An area of significant space-time clustering was identified, with an incidence of 22.9 cases/100 000/year (95%CI 16.1-31.6), but there was no evidence of seasonality.

Discussion: The submerged component of the ‘coeliac iceberg’ may be diminishing due to increasing case ascertainment, with a projected ratio of undiagnosed to diagnosed cases as low as 1.5:1. Our identification of clustering must be interpreted with caution, but suggests that an additional environmental factor may influence the pathogenesis of CD.


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