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Childhood coeliac disease diagnoses in Scotland 2009-2010: the SPSU project
Lois E White1, Elaine Bannerman, Paraic McGrogan
1Department of Dietetics, Nutrition and Biological Sciences, School of Health Sciences, Queen Margaret University, Edinburgh, UK.
Insights
Childhood coeliac disease (CD) incidence in Scotland was 10.0/100,000/year, with higher rates and active screening in the East. This suggests regional differences in diagnosis and potential environmental factors.
Area of Science:
- Pediatric Gastroenterology
- Epidemiology
- Immunology
Background:
- Childhood coeliac disease (CD) is an autoimmune disorder triggered by gluten ingestion.
- Understanding regional incidence and diagnostic practices is crucial for public health.
- Previous studies have indicated geographical variations in CD prevalence.
Purpose of the Study:
- To determine the incidence of pediatric CD in Scotland from September 2009 to August 2010.
- To analyze clinical features and diagnostic reasons for CD in children.
- To identify regional disparities in CD incidence and diagnostic approaches.
Main Methods:
- A prospective national study using the Scottish Paediatric Surveillance Unit (SPSU).
- Monthly reporting of new CD cases (<16 years) from strategic contacts in three tertiary gastrointestinal regions.
- Collection of clinical questionnaires and regional laboratory data on CD antibody tests.
Main Results:
- 91 new cases of pediatric CD were reported, yielding an adjusted incidence of 10.0/100,000/year.
- The East region showed a significantly higher incidence (16.3/100,000/year) compared to the West (8.1) and North (7.7).
- Higher rates of active screening, asymptomatic cases, and CD antibody tests were observed in the East, suggesting a lower testing threshold.
Conclusions:
- Paediatric CD incidence in Scotland is geographically variable, with approximately double the rate in the East.
- Regional differences in diagnostic practices, including a lower threshold for testing in the East, are evident.
- The higher incidence of classic cases in the East warrants further research into potential environmental influences on CD development.
Objectives:
To establish the incidence of childhood coeliac disease (CD) in Scotland between 1 September 2009 and 31 August 2010, to determine clinical features at presentation and reasons for diagnosis, and to identify any differences in incidence and practice between regions.
Design:
Prospective data collection through the Scottish Paediatric Surveillance Unit (SPSU). Strategic contacts in each tertiary gastrointestinal region (East, West and North) were emailed monthly to report new cases of CD (<16 years). A clinical questionnaire was completed for each case. Additionally, regional laboratories were asked to report the number of diagnostic antibody tests for CD performed over the year.
Setting:
This national study looked at the total cases within Scotland. Scotland has a population of 5.2 million, with the mid-year estimate in 2009 of 912 144 children under the age of 16.
Results:
91 new cases were reported, giving an overall adjusted incidence of 10.0/100 000/year. Incidence in the East was 16.3/100 000/year, West 8.1/100 000/year and North 7.7/100 000/year. Cases diagnosed due to active screening in the East (4.6/100 000/year) were more than twice the number observed in the West (2.0/100 000/year) and North (1.3/100 000/year), as was the incidence of classic cases. The most frequent symptoms reported were abdominal pain (50/91; 54.9%), failure to thrive (29/91; 31.9%), fatigue (29/91; 31.9%), diarrhoea (27/91; 29.7%) and bloating (19/91; 20.9%). Twenty-two children (24.2%) were diagnosed due to active screening, of which 14 had associated type 1 diabetes mellitus, one Down syndrome and seven had family history. Fifty-five per cent (12/22) of the patients diagnosed through active screening were asymptomatic. Significantly more CD diagnostic antibody tests were performed per head of population in the East compared with the West (OR 1.65, 95% CI 1.57 to 1.73) and North (OR 1.81, 95% CI 1.70 to 1.92).
Conclusions:
Approximately double the incidence of paediatric CD was observed in the East of Scotland. Evidence of more actively screened cases diagnosed and more antibody tests performed in the region suggests a lower threshold to test. An environmental influence cannot be dismissed since more classic cases were also captured. Further research is needed to highlight the role of any exogenous factors.
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