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Original research
Evolving patterns in the presentation of coeliac disease over the last 25 years
  1. Callan Stroud1,
  2. Orouba Almilaji1,
  3. David Nicholas2,
  4. Silvia Kirkham1,
  5. Susan L Surgenor1,
  6. Imogen Williams1,
  7. Jonathon Snook1
  1. 1 Gastroenterology, Poole Hospital NHSFT, Poole, UK
  2. 2 Histopathology, Poole Hospital NHSFT, Poole, UK
  1. Correspondence to Dr Jonathon Snook, Gastroenterology, Poole Hospital NHSFT, Poole BH11 9NG, UK; jonathon.snook{at}


Objective To document changes in the clinical features of coeliac disease (CD) at presentation over the last 25 years.

Design Observational study.

Patients 802 subjects diagnosed between 1993 and 2017 at a single general hospital.

Outcome measures Date of diagnosis, age, sex, postcode, symptoms, haematinic deficiency, smoking status, serology, family history and autoimmune phenomena.

Results The incidence of diagnosed CD rose threefold during the course of the study, with a rising prevalence of positive coeliac serology and positive family history of CD, and a falling prevalence of symptoms and haematinic deficiencies. There was little change in the female predominance, age at diagnosis or high prevalence of other autoimmune conditions over the 25 years, and a paucity throughout of cigarette smokers, particularly heavy smokers. A cohort of patients with seronegative CD was identified who shared many of the characteristics of seropositive CD, but with a significantly older age at diagnosis and a higher prevalence of cigarette smokers.

Conclusion There have been major changes in the epidemiology of CD over the last 25 years, of relevance to both our understanding of the aetiopathogenesis of CD and the requirement for service provision. The implications are discussed.

  • coeliac disease
  • epidemiology

Statistics from


  • Contributors The study was devised by IKW and JAS, data collection was by DSN, SK and SLS, and the report was written by CS, OAM and JAS. All authors approved the final draft, and the guarantor is JAS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No data are available.

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