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Increased rate of abdominal surgery both before and after diagnosis of celiac disease
Matthew Kurien1, David S Sanders1, Anders Ekbom2
1Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom; Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
Insights
Patients with celiac disease (CD) face a higher risk of abdominal surgery, both before and after diagnosis. This suggests diagnostic delays and surgical complications may be linked to CD. Increased awareness is crucial.
Area of Science:
- Gastroenterology
- Epidemiology
- Surgical Oncology
Background:
- Celiac disease (CD) detection rates are suboptimal.
- Misdiagnosis may lead to diagnostic delays in CD patients.
- Investigating surgical risk can reveal diagnostic delays.
Purpose of the Study:
- To test the hypothesis that misdiagnosis causes diagnostic delays in CD.
- To determine if CD patients have an increased risk of abdominal surgery prior to diagnosis.
Main Methods:
- Identified 29,096 individuals with CD (Marsh stage 3) from Swedish biopsy reports.
- Compared abdominal surgery rates in CD patients versus 144,522 matched controls.
- Used conditional logistic regression to analyze odds ratios for surgery.
Main Results:
- Individuals with CD showed a 36% increased risk of prior abdominal surgery (OR=1.36).
- The risk was highest within the first year post-surgery (OR=2.00).
- Abdominal surgery was also more common after CD diagnosis (HR=1.34).
Conclusions:
- Increased abdominal surgery risk exists both before and after CD diagnosis.
- Surgical complications linked to CD may explain these findings.
- Lack of CD awareness and medical nihilism may contribute to delayed diagnosis and outcomes.
Background:
The detection of celiac disease (CD) is suboptimal.
Aims:
We hypothesized that misdiagnosis is leading to diagnostic delays, and examine this assertion by determining if patients have increased risk of abdominal surgery before CD diagnosis.
Methods:
Through biopsy reports from Sweden's 28 pathology departments we identified all individuals with CD (Marsh stage 3; n=29,096). Using hospital-based data on inpatient and outpatient surgery recorded in the Swedish Patient Register, we compared abdominal surgery (appendectomy, laparotomy, biliary tract surgery, and uterine surgery) with that in 144,522 controls matched for age, sex, county and calendar year. Conditional logistic regression estimated odds ratios (ORs).
Results:
4064 (14.0%) individuals with CD and 15,760 (10.9%) controls had a record of earlier abdominal surgery (OR=1.36, 95% CI=1.31-1.42). Risk estimates were highest in the first year after surgery (OR=2.00; 95% CI=1.79-2.22). Appendectomy, laparotomy, biliary tract surgery, and uterine surgery were all associated with having a later CD diagnosis. Of note, abdominal surgery was also more common after CD diagnosis (hazard ratio=1.34; 95% CI=1.29-1.39).
Conclusions:
There is an increased risk of abdominal surgery both before and after CD diagnosis. Surgical complications associated with CD may best explain these outcomes. Medical nihilism and lack of CD awareness may be contributing to outcomes.
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