Female fertility, obstetric and gynaecological history in coeliac disease: a case control study.

OBJECTIVES: The purpose of this study was to investigate the incidence of infertility, abortions and perinatal mortality, age at menarche and menopause in coeliac disease. METHOD: This was a case control study in which patients and controls, matched for age and sex, were sent questionnaires about their fertility profile and other obstetric and gynaecological problems. All 80 patients and 70 controls replied, but only 68 pairs could be matched for this study. RESULTS: The mean age of menarche in patients was significantly older (13.6 years) than in controls (12.7 years). The mean ages at menopause in patients and controls were 47.6 and 50.1 years, respectively. The mean number of children born to patients was significantly less at 1.9 (SD +/- 0.9) compared to 2.5 (SD +/- 1.2) in controls. Before diagnosis the mean number of children born to patients was 1.4 and 1.8 in controls. After diagnosis and treatment, patients had 0.5 children (SD +/- 0.9) compared to 0.7 in controls (SD +/- 1.2). It seems likely that the overall difference in fertility is due to relative infertility prior to diagnosis and its correction by a gluten-free diet. Significantly more conceptions amongst women with coeliac disease (15%) ended in miscarriage prior to diagnosis than amongst controls (6%). After diagnosis and treatment the rate of miscarriage was similar. There were 120 live babies and 7 stillbirths to patients compared with 161 live babies and 1 stillbirth to controls. CONCLUSIONS: Patients with CD are subfertile and have an increased incidence of stillbirths and perinatal deaths.

Infertility, obstetric and gynaecological problems in coeliac sprue.

There is now substantial evidence that coeliac sprue is associated with infertility both in men and women. In women it can also lead to delayed menarche, amenorrhoea, early menopause, recurrent abortions, and a reduced pregnancy rate. In men it can cause hypogonadism, immature secondary sex characteristics and reduce semen quality. The real mechanism by which coeliac sprue produces these changes is unclear, but factors such as malnutrition, iron, folate and zinc deficiencies have all been implicated. In addition in men gonadal dysfunction is believed to be due to reduced conversion of testosterone to dihydrotestosterone caused by low levels of 5 alpha-reductase in coeliac sprue. This leads to derangement of the hypothalamic-pituitary axis. Hyperprolactinaemia is seen in 25% of coeliac patients, which causes impotence and loss of libido. Gluten withdrawal and correction of deficient dietary elements can lead to a return of fertility both in men and women.

Female fertility, obstetric and gynaecological history in coeliac disease. A case control study.

The purpose of this study was to investigate the incidence of infertility, abortions and perinatal mortality, age at menarche and menopause in coeliac disease (CD). It was a case control study in which patients and controls matched for age and sex were sent questionnaires about their fertility profile and other obstetric and gynaecological problems. All 80 patients and 70 controls replied but only 68 groups could be matched for this study. The mean age of menarche in patients was significantly older at 13.6 years than in controls at 12.7 years. The mean age at menopause in patients and controls were 47.6 and 50.1 years respectively. The study showed the mean number of children born to patients with CD was significantly less at 1.9 (SD +/- 0.9) compared to 2.5 (SD +/- 1.2) in controls. Before diagnosis the mean number of children born to patients was 1.4 and 1.8 in controls. After diagnosis and treatment, patients had 0.5 children (SD +/- 0.9) compared to 0.7 in controls (SD +/- 1.2). It seems likely that the overall difference in fertility is due to relative infertility prior to diagnosis and its correction by a gluten-free diet. Significantly more conceptions amongst women with CD (15%) ended in miscarriage prior to diagnosis than amongst controls (6%). After diagnosis and treatment the rate of miscarriage was similar at 7 and 12% respectively. There were 120 live babies and 7 stillbirths to patients compared with 161 live babies and 1 stillbirth to controls. In conclusion, this study shows that patients with CD are subfertile and have an increased incidence of stillbirths and perinatal deaths.

High risk of coeliac disease in Punjabis. Epidemiological study in the south Asian and European populations of Leicestershire.

The purpose of this study was to measure the incidence of coeliac disease in different ethnic communities and investigate the hypothesis that the incidence is decreasing in most European countries and the role incomplete retrieval of data may play. In a retrospective study of histologically confirmed cases of coeliac disease between 1975 and 1989 in the City of Leicester, 106 patients with coeliac disease were identified. Of these 86 were European and 20 Asian. The overall incidence of coeliac disease in Europeans was 2.5/10(5)/year (95% CI 2-3.2), in Gujaratis 0.9/10(5)/year (95% CI 0.4-1.8), and in Punjabis 6.9 (95% CI 3.2-12.3). These differences were independent of religious belief. The relative risk to Punjabis compared with Europeans is 2.9 (95% CI 1.5-5.3; chi 2 = 12.5, p < 0.01) and to Gujaratis 8.1 (95% CI 3-22.4; chi 2 = 25; p < 0.001). Gujaratis were at 0.4 risk of Europeans (90% CI 0.2-0.8; chi 2 = 6.7; p < 0.01). The incidence in the urban populations of Leicester was 6/10(5)/year (95% CI 1.3-1.9) which was significantly lower than the 3.2/10(5)/year (95% CI 2.7-3.8; chi 2 = 5.6; p < 0.001) in surrounding rural areas. This study shows that the incidence of coeliac disease in Punjabis (Sikhs, Hindus and Muslims) is 8 times higher than in Gujaratis (Hindus and Muslims) and 4 times higher than in Europeans in Leicester.

The renaissance of abdominal tuberculosis.

During the last decade, abdominal tuberculosis (TB) has experienced a renaissance. The number of cases diagnosed in Western European and North American countries has dramatically increased. The reasons for this are multiple and include the appearance of AIDS as a significant disorder and the increased morbidity of peoples across the world with the migration of many people from areas of high incidence of TB to the West. Recent epidemiological work is reviewed, and its relationship to these changes considered. The distribution of disease along the gastrointestinal tract and in the mesentery is discussed. The frequency of involvement at various sites and the clinical symptoms caused by the disease are reviewed. The need to diagnose abdominal TB in the 1990s is considered in detail in areas where the disease had previously been thought rare.