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Increased rate of abdominal surgery both before and after diagnosis of celiac disease
Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom; Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom; Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
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2017 (English)In: Digestive and Liver Disease, ISSN 1590-8658, E-ISSN 1878-3562, Vol. 49, no 2, 147-151 p.Article in journal (Refereed) Published
Abstract [en]

Background: The detection of celiac disease (CD) is suboptimal.

Aims: We hypothesized that misdiagnosis is leading to diagnostic delays, and examine this assertion by determining if patients have increased risk of abdominal surgery before CD diagnosis.

Methods: Through biopsy reports from Sweden's 28 pathology departments we identified all individuals with CD (Marsh stage 3; n=29,096). Using hospital-based data on inpatient and outpatient surgery recorded in the Swedish Patient Register, we compared abdominal surgery (appendectomy, laparotomy, biliary tract surgery, and uterine surgery) with that in 144,522 controls matched for age, sex, county and calendar year. Conditional logistic regression estimated odds ratios (ORs).

Results: 4064 (14.0%) individuals with CD and 15,760 (10.9%) controls had a record of earlier abdominal surgery (OR=1.36, 95% CI=1.31-1.42). Risk estimates were highest in the first year after surgery (OR=2.00; 95% CI=1.79-2.22). Appendectomy, laparotomy, biliary tract surgery, and uterine surgery were all associated with having a later CD diagnosis. Of note, abdominal surgery was also more common after CD diagnosis (hazard ratio=1.34; 95% CI=1.29-1.39).

Conclusions: There is an increased risk of abdominal surgery both before and after CD diagnosis. Surgical complications associated with CD may best explain these outcomes. Medical nihilism and lack of CD awareness may be contributing to outcomes.

Place, publisher, year, edition, pages
Elsevier, 2017. Vol. 49, no 2, 147-151 p.
Keyword [en]
Appendix, autoimmunity, celiac, gall bladder, inflammation, surgery
National Category
Gastroenterology and Hepatology Surgery
Identifiers
URN: urn:nbn:se:oru:diva-55424DOI: 10.1016/j.dld.2016.09.012ISI: 000394072200004PubMedID: 27765577Scopus ID: 2-s2.0-85005810452OAI: oai:DiVA.org:oru-55424DiVA: diva2:1080621
Funder
Swedish Society of Medicine
Note

Funding Agency:

Stockholm County Council

Available from: 2017-03-10 Created: 2017-03-10 Last updated: 2017-10-18Bibliographically approved

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Ludvigsson, Jonas F
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