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A multicentre case control study on complicated coeliac disease: two different patterns of natural history, two different prognoses.

Biagi F, Marchese A, Ferretti F, Ciccocioppo R, Schiepatti A, Volta U, Caio G, Ciacci C, Zingone F, D'Odorico A, Carroccio A, Ambrosiano G, Mansueto P, Gasbarrini A, Piscaglia AC, Andrealli A, Astegiano M, Segato S, Neri M, Meggio A, de Pretis G, De Vitis I, Gobbi P, Corazza GR - BMC Gastroenterol (2014)

Bottom Line: Thirty-seven cases died (30/59 in group A, 7/28 in group B).Type B cases presented an increased survival rate compared to A cases.Survival depends on the type of natural history.

View Article: PubMed Central - HTML - PubMed

Affiliation: Coeliac Centre/First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, P,le Golgi, 19, I-27100, Pavia, Italy. f.biagi@smatteo.pv.it.

ABSTRACT

Background: Coeliac disease is a common enteropathy characterized by an increased mortality mainly due to its complications. The natural history of complicated coeliac disease is characterised by two different types of course: patients with a new diagnosis of coeliac disease that do not improve despite a strict gluten-free diet (type A cases) and previously diagnosed coeliac patients that initially improved on a gluten-free diet but then relapsed despite a strict diet (type B cases). Our aim was to study the prognosis and survival of A and B cases.

Methods: Clinical and laboratory data from coeliac patients who later developed complications (A and B cases) and sex- and age-matched coeliac patients who normally responded to a gluten-free diet (controls) were collected among 11 Italian centres.

Results: 87 cases and 136 controls were enrolled. Complications tended to occur rapidly after the diagnosis of coeliac disease and cumulative survival dropped in the first months after diagnosis of complicated coeliac disease. Thirty-seven cases died (30/59 in group A, 7/28 in group B). Type B cases presented an increased survival rate compared to A cases.

Conclusions: Complicated coeliac disease is an extremely serious condition with a high mortality and a short survival. Survival depends on the type of natural history.

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Related in: MedlinePlus

Kaplan Meier curve showing the cumulative survival from diagnosis of complicated coeliac disease until time of death in the 87 cases.
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Figure 2: Kaplan Meier curve showing the cumulative survival from diagnosis of complicated coeliac disease until time of death in the 87 cases.

Mentions: The mortality of this condition is extremely high, since only 50 out of the 87 cases (58%) were still alive when these data were collected. Figure 2 shows the cumulative survival of the 87 cases, starting from the time at which CCD was diagnosed. It can be observed that survival was drastically reduced in the first 6 months and continued to be reduced, albeit more slowly, up to 5 years after the diagnosis of CCD. Once this limit has been passed, the survival seems to stabilize.Figure 3 shows the cumulative survival at 10 years according to the two different types of natural history. Type B cases presented an increased survival rate compared to type A cases (logrank, p = 0.0006).


A multicentre case control study on complicated coeliac disease: two different patterns of natural history, two different prognoses.

Biagi F, Marchese A, Ferretti F, Ciccocioppo R, Schiepatti A, Volta U, Caio G, Ciacci C, Zingone F, D'Odorico A, Carroccio A, Ambrosiano G, Mansueto P, Gasbarrini A, Piscaglia AC, Andrealli A, Astegiano M, Segato S, Neri M, Meggio A, de Pretis G, De Vitis I, Gobbi P, Corazza GR - BMC Gastroenterol (2014)

Kaplan Meier curve showing the cumulative survival from diagnosis of complicated coeliac disease until time of death in the 87 cases.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4127435&req=5

Figure 2: Kaplan Meier curve showing the cumulative survival from diagnosis of complicated coeliac disease until time of death in the 87 cases.
Mentions: The mortality of this condition is extremely high, since only 50 out of the 87 cases (58%) were still alive when these data were collected. Figure 2 shows the cumulative survival of the 87 cases, starting from the time at which CCD was diagnosed. It can be observed that survival was drastically reduced in the first 6 months and continued to be reduced, albeit more slowly, up to 5 years after the diagnosis of CCD. Once this limit has been passed, the survival seems to stabilize.Figure 3 shows the cumulative survival at 10 years according to the two different types of natural history. Type B cases presented an increased survival rate compared to type A cases (logrank, p = 0.0006).

Bottom Line: Thirty-seven cases died (30/59 in group A, 7/28 in group B).Type B cases presented an increased survival rate compared to A cases.Survival depends on the type of natural history.

View Article: PubMed Central - HTML - PubMed

Affiliation: Coeliac Centre/First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, P,le Golgi, 19, I-27100, Pavia, Italy. f.biagi@smatteo.pv.it.

ABSTRACT

Background: Coeliac disease is a common enteropathy characterized by an increased mortality mainly due to its complications. The natural history of complicated coeliac disease is characterised by two different types of course: patients with a new diagnosis of coeliac disease that do not improve despite a strict gluten-free diet (type A cases) and previously diagnosed coeliac patients that initially improved on a gluten-free diet but then relapsed despite a strict diet (type B cases). Our aim was to study the prognosis and survival of A and B cases.

Methods: Clinical and laboratory data from coeliac patients who later developed complications (A and B cases) and sex- and age-matched coeliac patients who normally responded to a gluten-free diet (controls) were collected among 11 Italian centres.

Results: 87 cases and 136 controls were enrolled. Complications tended to occur rapidly after the diagnosis of coeliac disease and cumulative survival dropped in the first months after diagnosis of complicated coeliac disease. Thirty-seven cases died (30/59 in group A, 7/28 in group B). Type B cases presented an increased survival rate compared to A cases.

Conclusions: Complicated coeliac disease is an extremely serious condition with a high mortality and a short survival. Survival depends on the type of natural history.

Show MeSH
Related in: MedlinePlus