Elsevier

The American Journal of Medicine

Volume 119, Issue 4, April 2006, Pages 355.e9-355.e14
The American Journal of Medicine

Clinical research study
Trends in the Presentation of Celiac Disease

https://doi.org/10.1016/j.amjmed.2005.08.044Get rights and content

Abstract

Purpose

Screening studies have revealed that celiac disease is common in the United States; however, there are scant data on the mode of presentation. We analyzed the trends in clinical presentation over the last 52 years in a large cohort of biopsy-proven patients seen in 1 center.

Subjects and methods

Patients (n = 590) were divided into 6 groups based on the year of diagnosis (1952-2004). Groups were compared for trends in age at diagnosis, childhood diagnosis, duration of symptoms, mode of presentation (diarrhea, bone disease, anemia, incidental at esophagogastroduodenoscopy, screening), and presence of malignancy.

Results

Diagnosis was at an older age since 1980 (P = .007), and there was a significant negative linear trend in patients presenting with diarrhea (P<.001) over time and a positive linear trend in asymptomatic patients detected on screening (P<.001). There was a significant negative linear trend in patients with a malignancy (P = .02) and duration of symptoms before diagnosis of celiac disease (P = .001), although only the subgroup without diarrhea had improvement in delay of diagnosis of celiac disease (assessed by a shorter duration of symptoms) (P = .05). Comparison of patients with and without diarrhea showed no significant difference in age (42.9 years vs 43.7 years, P = .59), gender (29.3% M vs 34.6%, P = .59), and presence of childhood disease (8.0% vs 9.8%, P = .43) or malignancies (9.8% vs 8.9%, P = .71).

Conclusion

There is a trend toward fewer patients presenting with symptomatic celiac disease characterized by diarrhea and a significant shift toward more patients presenting as asymptomatic adults detected at screening.

Section snippets

Study Design and Subjects

All patients presenting to the Celiac Disease Center at Columbia Presbyterian Medical Center in New York City between 1981 and 2004 were entered into a database that was anonymized to protect patient privacy. Patients seen before 1990 were retrospectively entered; subsequent data were entered prospectively. Data including age, gender, date of diagnosis, age at initial diagnosis, presence or absence of small bowel biopsy, duration of symptoms before diagnosis, and mode of presentation were

Clinical Features and Modes of Presentation of Patient Population

A total of 590 patients with biopsy-proven celiac disease were included in the study. The patients were predominantly women (401 women and 189 men, ratio 2.1:1). Mean age at diagnosis was 43.4 ± 17.4 years (range 16-83 years). The mean age at diagnosis was similar in men and women (44.9 ± 18.7 years and 42.7 ± 16.8 years, respectively; P = 0.16). Of the 590 patients, 25.1% had a known family history of celiac disease, and 9% were initially diagnosed in childhood and subsequently rediagnosed as

Discussion

Serologic screening studies from several countries have demonstrated celiac disease to be common, occurring in approximately 1% of the population.6, 7, 8 This far exceeds the prevalence of clinically diagnosed celiac disease,9 indicating that the majority of those with celiac disease are currently undiagnosed. In addition, there have been only 2 recent studies describing the clinical presentation of celiac disease in the United States.3, 4 In each of these studies, there was recognition that

Conclusion

Celiac disease is becoming increasingly recognized in the adult population without diarrhea, with a larger percentage of patients presenting as asymptomatic individuals often detected by screening affected families. The atypical forms are, in fact, becoming the typical. The natural history of this milder form of celiac disease has not been determined.

References (18)

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