Role of age at diagnosis and clinical type of coeliac disease in the incidence of complicated coeliac disease.

Abstract

Background and Aims: Coeliac disease (CD) is a chronic enteropathy characterized by an increased mortality mainly due to its complications, i.e. refractory CD, abdominal lymphomas, and small bowel carcinoma. Recently, it was shown that overall annual incidence of these complications in CD patients is 0.2%. However, some evidence suggests that risk of developing complications varies in different type of coeliac patients, type of clinical presentation and age at diagnosis of CD being the most important discriminant factors. To calculate the risk of developing compilations according to type of clinical presentation and age at diagnosis of CD. Methods: The data obtained from our previous study were reanalysed to calculate the incidence of complicated CD among coeliac patients according to type of clinical presentation and age at diagnosis of CD. Results: Between Jan 1999 and Oct 2011, 14 (11 F, mean age at diagnosis of complication 61+12 yrs) out of 1840 coeliac patients (1379 F, mean age at diagnosis of CD 35+11 yrs) developed complications (5 refractory CD type I, 2 refractory CD type Il, 2 ulcerative jejunal-ileitis, 3 small bowel adenocarcinomas, 1 B-lymphoma, 1 enteropathy-associated T-cell lymphoma). Relative risk of complications was found to be directly related to age at diagnosis of CD: it was 4,8 for patients diagnosed at age of 30 years, 13.5 at 50 years. and 38.1 at 70 years. 622 out of 1840 coeliac patients were affected by a classical/major form of CD and 13 of them developed complications. Relative risk for these patients was much higher and again it was directly related to age at diagnosis of CD: it was 21.7 for patients diagnosed at age of 30 years, 168.7 at 50 years, and 1311.5 at 70 years. Conclusions: Risk of developing complications in coeliac patients is strongly linked to age at diagnosis and type of clinical presentation of CD. So, follow-up modalities of coeliac patients will have to be tailored according to these individual parameters.