EPIDEMIOLOGY OF CELIAC DISEASE--A POPULATION BASED STUDY

在欧洲部分地区，乳糜泻被认为是最常见的慢性自身免疫性疾病之一。它已被认为是导致严重发病率和恶性肿瘤风险增加的原因之一。乳糜泻在美国被认为是相当罕见的。因为它被认为是罕见的，在许多常见疾病的鉴别诊断中很少被考虑。由于一般人群筛查需要耗费大量资源，因此研究最有可能罹患该病的人群的流行情况将是有意义的。如果它在这些群体中的存在水平与乳糜泻常见国家的水平相同，那么这将证明有理由考虑进行更广泛的筛查。这项研究的目的是检查乳糜泻在那些被认为风险最高的人群中的患病率：1型糖尿病、乳糜泻家族史或疱疹样皮炎；骨质疏松症、伴有腹痛的慢性腹泻和缺铁性贫血(特定目标1)。我们将使用标准化的有效胃肠道问卷来确定谁可能患有乳糜泻的任何临床预测因素(特定目标2)。我们的目标是研究在欧洲人群中看到的人类白细胞抗原相关性是否不会被美国更具异质性的人群改变，并筛选其他预测美国乳糜泻患者疾病风险的人类白细胞抗原基因型别(特定目标编号3)。如果乳糜泻是一种常见的疾病，也就是没有诊断出来，那么重要的是要知道当诊断做出后，个人会得到什么好处(或坏处)。研究作为筛查结果的CD的诊断如何影响胃肠道和非胃肠道症状、患者的生活质量和医疗资源的利用(特定目标4)。如果这项提议表明，乳糜泻比人们认为的更常见，它将为它影响到谁、如何检测病情或预测风险提供重要的见解，同时在减轻痛苦、改善功能和减少卫生保健利用方面都显示出实质性的好处。这将是可能的，因为将被诊断为CD的受试者实际上将生活在奥姆斯特县，他们的病史和正在进行的医疗护理将被记录在罗切斯特流行病学项目积累的社区医疗记录中。

In parts of Europe celiac disease is considered one of the most common chronic autoimmune diseases. It has been identified as a cause of significant morbidity and an increased risk of malignancies. Celiac disease is thought to be quite rare in the United States. Because it is thought to be rare, it is rarely considered in the differential diagnosis of many common conditions. As general population screening requires a great expenditure of resources it would make sense to study the prevalence of the disease in those groups of people most likely to have it. If it is present in these groups at the same level as has been seen in countries where celiac disease is common then this would justify consideration of more widespread screening. This study aims to examine the prevalence of celiac disease in those thought most at risk: Type one diabetes, family history of celiac disease or dermatitis herpetiformis; osteoporosis, chronic diarrhea with abdominal pain, and iron deficiency anemia (Specific aim number 1). We will use standardized validated gastrointestinal questionnaires to identify any clinical predictors of the who may have celiac disease (Specific aim number 2). We aim to study whether the HLA associations seen in European populations are unaltered by the more heterogenous population of the US and screen for other predictive HLA genotypes for disease risk in American celiacs (Specific aim number 3). If celiac disease is a common condition, that is undiagnosed, it is important to know what benefit (or detriment) may accrue to the individual when the diagnosis has been made. To study how making the diagnosis of CD as the result of a screening project affects both gastrointestinal and non- gastrointestinal symptoms, the patient's quality of life, and the utilization of health care resources (Specific aim number 4). If this proposal demonstrates that celiac disease is more common than believed, it will provide important insights into who it affects, how to detect the condition or predict risk, while demonstrating a substantial benefit in both relief of suffering, improved functioning and reduced utilization of health care. This will be possible, because the subjects who will be diagnosed with CD will actually live in Olmsted County, and their medical histories and ongoing medical care will be recorded in community medical records accumulated by the Rochester Epidemiology Project.