Arvo building, auditorium F115, address: Arvo Ylpön katu 34.
Doctoral defence of Lic.Med. Laura Kivelä
The field of science of the dissertation is Paediatrics.
The opponent is MD, PhD Ketil Størdal (Norwegian Institute of Public Health, Norway). Professor Kaija-Leena Kolho acts as the custos.
The language of the dissertation defence is English.
Coeliac disease in children: from changing presentation towards screening
Up to 1-3% of children are known to suffer from coeliac disease, in which dietary gluten drives small-bowel mucosal damage and different symptoms. Some patients are asymptomatic and possible to find only by screening. The risk of developing the disease is higher particularly in patients suffering from certain other autoimmune diseases and in close relatives of coeliac disease patients, and screening evaluations could be focused on them. Despite improved knowledge and better diagnostic methods, the great majority of the patients remain unrecognized. Ongoing symptoms decrease quality of life and increase the use of health-care services. Furthermore, untreated coeliac disease may be associated with the risk to develop severe complications. However, whether the risk for complications is similar in symptomatic and asymptomatic, screen-detected patients is not known. Treatment for coeliac disease is a strict, life-long gluten-free diet, and whether screen-detected patients who may have considered themselves healthy before the diagnosis, experience the burden of the diet higher than possible benefits should be further studied.
Dissertation project consists of three original publications, which evaluated changes in the clinical presentation of paediatric coeliac disease, and characteristics and long-term health of risk-group screened children at diagnosis and on a gluten-free diet. Data were collected of children diagnosed with coeliac disease in Finland during 48 years from patient records and in some cases supplemented with interviews, and currently adult patients were invited to answer specific study questionnaires.
We saw that clinical presentation of coeliac disease changed significantly and became milder especially in the 1980s and 1990s, whereas most of the changes reached a plateau in the twenty-first century. Currently, children diagnosed with coeliac disease are on average 8 years old, half of them have gastrointestinal symptoms and up to one-third of them are found due to at-risk screening. Even half of the patients found by screening suffered from previously unrecognized symptoms, anaemia or poor growth, and their severity of small-bowel damage was comparable to clinically found patients. The groups did not differ in dietary adherence, most aspects of quality of life, or their experiences with the disease and its treatment in adulthood.
Results of the present study clarify the changes in the clinical presentation of coeliac disease during this long time period and increase the knowledge about the current clinical features thus helping to improve the diagnostics. Screen-detected patients may have an advanced small-bowel damage, which together with successful dietary treatment and a good long-term prognosis supports systematic screening for coeliac disease among at-risk children.
The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2425, Tampere University Press, Tampere 2018. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1935, Tampere University Press 2018.