The rising incidence of celiac disease in Scotland

Background and objectives: Although the incidence of pediatric celiac disease (CD) is increasing globally, it is uncertain whether this is attributed to improved case ascertainment or signifies a true rise. We aimed to identify all incident cases of childhood CD in southeast Scotland over the period 1990 to 2009 to assess trends in totalincidence and cases diagnosed as a result of (1) a classic presentation, (2) a nonclassic presentation, or (3) targeted screening. Methods: Twenty-year retrospective cohortstudy of case notes, pathology databases, endoscopy, and patient records for all children (<16 years of age) diagnosed with CD on biopsy in southeast Scotland (at-riskpopulation of 225 000-233 000). Data were age-gender standardized and Poisson regression models used to calculate changes in incidence over time. Results: A total of 266 children were diagnosed from 1990 to 2009 with an increase in incidence from 1.8/100 000(95% confidence interval [CI] 1.1-2.7) to 11.7/100 000 (95% CI 9.8-13.9) between the epochs 1990 to 1994 and 2005 to 2009, respectively (P < .0001). The incidence of nonclassic presentation (children with a monosymptomatic presentation and those with extraintestinal symptoms) and actively screened cases increased by 1566% (P < .05) and 1170% (P < .001) from 1990 to 1999 to 2000 to 2009, respectively. However, a rise in the incidence of Oslo classic cases from 1.51/100 000 (95% CI 0.91-2.38) in 1990 to 1994 to 5.22/100 000 (95% CI 3.98-6.75) in 2005 to 2009 (P < .01) remained evident. Conclusions: The incidence of pediatric CD increased 6.4-fold over the 20 years. This study demonstrates that this rise is significant for classic CD, indicating a true rise in the incidence of pediatric CD. 2013 by the American Academy of Pediatrics.sch_die132pub3280pub