Coeliac disease: on the rise or just being reported more?

Professor Peter Gibson asks the question of whether the reported
rise of coeliac disease is due to the rise in incidence or detection.

by Anne Crawford

It’s a question pondered in both medical science and the community: does the rising rate of a chronic disease – in this case, coeliac disease – mean that it is being detected more or is the rate of the disease really rising? Or both?

The distinction is critical to clinical and scientific responses to such changes, Head of the Department of Gastroenterology Professor Peter Gibson argues in a recent opinion piece in Alimentary Pharmacology and Therapeutics. The journal was commemorating landmark studies published over the last decade or two, including that of seminal research on coeliac disease rates by Lohi et al in 2007.


“If the frequency of coeliac disease is really rising, we need to determine why, so that strategies can be devised and implemented to halt, and hopefully reverse, this trend,” Professor Gibson said.

Coeliac disease is a chronic autoimmune disease in which the immune system reacts to the ingestion of gluten (found in wheat, rye, barley and oats). According to Coeliac Australia, it affects on average approximately 1 in 70 Australians. However, around 80% of this number remains undiagnosed.

There are many reasons why the detection of coeliac disease has increased, Professor Gibson writes. Serological screening – blood tests measuring antibody levels in the blood – have improved in sensitivity and specificity, allowing accurate estimates of the disease to be made in large populations.

Awareness of coeliac disease has markedly increased over time both in the community and among physicians. The popularity of a gluten‐free diet for non-coeliac conditions and for ‘good health’ has no doubt heightened awareness, he says.

Against this background, there is a need to map over time the true prevalence of the disease, Professor Gibson stresses. The ground-breaking study by Lohi et al did this, finding a doubling in the rates of coeliac disease in Finland in the two decades from 1978–80.

“Because these researchers were using the same very accurate method of testing for the disease over a long time, they were able to determine the frequency of both clinically diagnosed coeliac disease and unrecognised disease from about 8,000 people in the late 1970s and compare the results with that from another 8,000 people two decades later,” Professor Gibson said. “Not only clinical diagnosis, but also unrecognised cases, had markedly increased. It was not just because we were better at picking up the disease!”

Other overseas studies have also documented rises in the disease.

A rise in true prevalence implicates changes in exposure to environmental factors with a wide variety of factors considered, including: the timing and amount of first gluten ingestion; overall or specific infections; various perinatal factors and medication exposure.  For most, evidence is conflicting or weak, the comment piece notes.

Like many immune‐mediated diseases, however, the shaping of the gut microbiota is a likely, though unproven, modifier of the development of coeliac disease.

“What we eat and how we live influence the microbial communities in our gut,” Professor Gibson said. “If we can understand what changes in the gut microbiota have partnered in this increase in coeliac disease, we may be able to use that knowledge to reduce its development by, for example, simple dietary and lifestyle modifications,” he said.

Gibson PR. Commentary: recognising the boom in coeliac disease prevalence was more than just increased awareness. Aliment Pharmacol Ther. 2020 Jan;51(1):207-208. doi: 10.1111/apt.15552.

To read the Lohi study
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2036.2007.03502.x