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New Clues to Risks From Celiac Disease

Study Shows Patients With Less Severe Form of Celiac Disease May Be at Higher Risk of Death

Celiac Disease and Death Risk continued...

But Ludvigsson puts the finding in perspective. The most important finding, he says, is the relatively low overall risk of death, even though it is increased. It translates, he says, "into very few actual deaths."

The researchers also found that those diagnosed before age 20 had nearly twice the risk of death, overall, but Ludvigsson says that, too, needs to be put into perspective. "Kids are at increased risk of mortality," he says. Even though the risk is increased, he says, it is still very low.

The higher risk in those with less severe disease, Ludvigsson says, may be because of the untreated inflammation, as those patients may not be told to follow a gluten-free diet.

The risk of death was found to be highest in the first year of follow-up, then decreased.

Deaths were often from malignancy or cardiovascular disease, the researchers found. Exactly why isn't known, but Ludvigsson says that the longtime inflammation associated with celiac disease may boost the risk of other disorders, such as heart disease and cancer.

Second Opinions

The findings that those in the less severe group have risk of death, and sometimes higher than others, are concerning, says Daniel Leffler, MD, director of clinical research at The Celiac Center, Beth Israel Deaconess Medical Center, Boston, and an assistant professor of medicine at Harvard Medical School, who reviewed the study for WebMD.

The other surprise to him was that the risk of death, although it declined after the first year of diagnosis, did not normalize. "Other studies have shown that once you treat, the risk of death goes back to that of the normal population. This study didn't show that. It went down but didn't go down to normal."

In an accompanying editorial, Peter Green, MD, a doctor at the Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, concludes that: "more attention should be given to the lesser degrees of intestinal inflammation and gluten sensitivity."

Even though the study didn't go into the effects of treatment, Ludvigsson says he thinks the advice is clear. "I believe the take-home message is: adhere to a gluten-free diet. Although this study did not show that gluten-free diet protects against death, there are strong indications that a gluten-free diet diminishes the risk of complications in celiac disease.'' 

Leffler agrees, noting that there is no way to know from the data whether or not the patients studied were adhering to a gluten-free diet. Treatment, he says, would be expected to have an important effect on death risk.

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