Royal Prince Alfred Hospital Royal Prince Alfred Hospital
Allergy Unit

Student research


The Prevalence of Coeliac Disease in 'At-Risk' Groups in the Australian Population

by
Louise Wienholt
Master of Science in Medicine, The University of Sydney
Supervisors: Andrew Williams, Robert Loblay
March 2006

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Abstract

Introduction: Coeliac disease (CD) is an immune mediated condition caused by the ingestion of gluten-containing grains in genetically susceptible individuals. Over the last 10 to 15 years a plethora of information on CD has emerged which has enabled us to better understand the genetics, pathogenesis, epidemiology and vast spectra of clinical manifestations of this disease. We now know CD to be a highly protean disease, with a prevalence of approximately 1:300, making it one of the world’s most common diseases. Despite this wealth of information CD is still significantly under diagnosed, even in subsets of patients that have been shown to be at increased risk of having the disease.

Aim: To assess the prevalence of CD in couples undergoing In-vitro fertilization, patients with diabetes mellitus type 1 (DM-1), subjects with decreased bone mineral density (BMD) and patients with low trauma fractures.

Methods: Subjects with infertility, osteopaenia/osteoporosis, low trauma fractures and diabetes mellitus type 1 were serologically screened for the presence of coeliac antibodies. Patients in these cohorts found to have biopsy proven CD were enrolled in long-term follow up studies to determine what symptoms the patient had on presentation, and the effect of a gluten free diet (GFD) over a 12 month period.

Results: The prevalence of CD was: 0.25% in subjects undergoing IVF treatment, 3.11% in patients with DM-1, 2.52% in patients with low BMD and 0.55% in patients with low trauma fractures. Twelve month follow up showed that the initiation of a GFD had many beneficial effects, such as increases in blood iron levels and BMD and resulted in the abrogation of many gastrointestinal symptoms.

Conclusion: CD is a highly prevalent disease. Specific subsets of patients show an increased prevalence of the disease and as such, routine serological screening for coeliac antibodies should be performed in these groups of patients.