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Burden of Illness and Use of Health Care Services Before and After Celiac Disease Diagnosis in Children

Mattila, Eeva*; Kurppa, Kalle; Ukkola, Anniina*; Collin, Pekka; Huhtala, Heini§; Forma, Leena§; Lähdeaho, Marja-Leena; Kekkonen, Leila||; Mäki, Markku; Kaukinen, Katri

Journal of Pediatric Gastroenterology and Nutrition: July 2013 - Volume 57 - Issue 1 - p 53–56
doi: 10.1097/MPG.0b013e31828ee55d
Original Articles: Gastroenterology

Objectives: Prevalence of celiac disease in children is approximately 1%, but most patients remain unrecognized by reason of variable clinical presentation. Undetected patients may have an increased burden of illness and use of health care services because of nonspecific complaints. We investigated these issues prospectively in newly detected patients with celiac disease before and after diagnosis in a large nationwide cohort of children.

Methods: A validated questionnaire was sent to consecutive families whose children had been diagnosed as having celiac disease within 1 year. The survey contained questions about the use of medical consultations, on-demand drugs, vitamins and herbal products, children's absenteeism from day care or school and, parents’ work absenteeism. A follow-up questionnaire was sent after 1 year of receiving a gluten-free diet.

Results: A total of 132 families responded. A total of 44 children were diagnosed because of gastrointestinal and 88 because of extraintestinal symptoms or by risk-group screening. On treatment, outpatient visits to primary health care decreased from a mean of 3.0 to 1.3 visits per year (P < 0.001), the number of hospitalizations from 0.2 to 0.1 (P = 0.008), and antibiotic prescriptions from 1.0 to 0.5/year (P < 0.001). Visits to secondary and tertiary health care increased from 0.6 to 1.4 (P < 0.001), mostly for celiac surveillance. Use of vitamins, micronutrients, and herbal products increased from 7.3 to 10.2 pills per month (P = 0.028).

Conclusions: Implementation of a gluten-free diet resulted in reduced use of health care services and antibiotic prescriptions in children. Our findings support active case-finding and risk-group screening for celiac disease.

*School of Medicine, University of Tampere

Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital

Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital

§School of Health Sciences, University of Tampere

||Finnish Celiac Society

Departments of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and Internal Medicine, Seinäjoki Central Hospital and School of Medicine, University of Tampere, Tampere, Finland.

Address correspondence and reprint requests to Katri Kaukinen, MD, PhD, University of Tampere, School of Medicine, FIN-33014 Tampere, Finland (e-mail:

Received 13 December, 2012

Accepted 23 February, 2013 registration number: NCT01145287.

This study was financially supported by the Academy of Finland Research Council for Health, the Finnish Medical Foundation, the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital, the Mary and Georg C. Ehrnrooth Foundation, the Foundation for Pediatric Research, the Maud Kuistila Foundation and the Sigrid Juselius Foundation.

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,