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Open Access Research article

Use of health care services and pharmaceutical agents in coeliac disease: a prospective nationwide study

Anniina Ukkola12, Kalle Kurppa2, Pekka Collin13, Heini Huhtala4, Leena Forma4, Leila Kekkonen5, Markku Mäki2 and Katri Kaukinen13*

Author Affiliations

1 School of Medicine, FinnMedi3, University of Tampere, Biokatu 10, FIN-33014, Tampere, Finland

2 Paediatric Research Centre, University of Tampere and Tampere University Hospital, Tampere, Finland

3 Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland

4 School of Health Sciences, University of Tampere, Tampere, Finland

5 Finnish Coeliac Society, Tampere, Finland

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BMC Gastroenterology 2012, 12:136  doi:10.1186/1471-230X-12-136

Published: 27 September 2012

Abstract

Background

Approximately 1% of the population suffer from coeliac disease. However, the disease is heavily underdiagnosed. Unexplained symptoms may lead to incremented medical consultations and productivity losses. The aim here was to estimate the possible concealed burden of untreated coeliac disease and the effects of a gluten-free diet.

Methods

A nationwide cohort of 700 newly detected adult coeliac patients were prospectively evaluated. Health care service use and sickness absence from work during the year before diagnosis were compared with those in the general population; the data obtained from an earlier study. Additionally, the effect of one year on dietary treatment on the aforementioned parameters and on consumption of pharmaceutical agents was assessed.

Results

Untreated coeliac patients used primary health care services more frequently than the general population. On a gluten-free diet, visits to primary care decreased significantly from a mean 3.6 to 2.3. The consumption of medicines for dyspepsia (from 3.7 to 2.4 pills/month) and painkillers (6.8-5.5 pills/month) and the number of antibiotic courses (0.6-0.5 prescriptions/year) was reduced. There were no changes in hospitalizations, outpatient visits to secondary and tertiary care, use of other medical services, or sickness absence, but the consumption of nutritional supplements increased on treatment.

Conclusions

Coeliac disease was associated with excessive health care service use and consumption of drugs before diagnosis. Dietary treatment resulted in a diminished burden to the health care system and lower use of on-demand medicines and antibiotic treatment. The results support an augmented diagnostic approach to reduce underdiagnosis of coeliac disease.

Trial registration

ClinicalTrials.gov NCT01145287

Keywords:
Coeliac disease; Gluten-free diet; Burden of illness; Health care service use; Sickness absence