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Cd Mortality

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Cd Mortality

  1. 1. Mortality in celiac disease Jonas F. Ludvigsson KI 2009
  2. 2. Earlier studies Celiac Disease Positive Serology 4 3 2 1 0 Collin Viljamaa West Logan Peters Corrao Solaym. Nielsen CottoneAnderss.Metzger
  3. 3. Biopsi 28
  4. 4. CD serology data from 8 university hospitals Latent CD, Normal mucosa but positiv CD serology
  5. 5. Validation Interobserver Linkage to reliability CD serology data Questionnaries: Patient Chart Reviews 1. Gastroenterol. 2. Pediatricians 3. Pathologists
  6. 6. Interobserver reliability Normal Borderline Villous atr. Normal 74 (96%) 3 0 77 Borderline 12 22 (56%) 5 39 Villous atr. 2 18 190 (90%) 210 Total 88 43 195 326
  7. 7. Biopsy prior to CD diagnosis 9-10/10 5-8/10 1-4/10 Never 1% 4% 100% N = 180 N = 68 96% Adults: 96% Children: 100%
  8. 8. Is villous atrophy equal to CD? Villous atrophy is clinical CD in 95% of cases CD Not CD 5% 95%
  9. 9. Is villous atrophy equal to CD? 79% of the validated individuals with VA and 64% of those with inflammation had documented gastrointestinal symptoms prior to biopsy. 88% of the validated individuals with VA had positive CD serology before their first biopsy.
  10. 10. 3,700 13,400 29,000
  11. 11. Overall mortality 95% CI for Number of HR p-value HR deaths Reference 1.00 1.00 23,633 5.42527 CD 1.39 (1.33-1.45) 3,049 E-53 2.7082 Inflammation 1.72 (1.64-1.79) 2,967 E-130 Latent CD 1.35 (1.14-1.58) 0.00034 183
  12. 12. Subanalyses Increased mortality: All age groups including children No difference over calendar period No difference between males/females Low absolute risks
  13. 13. The End

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