Celiac Disease: Similar Presentations in the Elderly and Young Adults
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Studies have shown that celiac disease can affect individuals in all age groups. However, few studies have described the disease in the elderly. The goal of this study is to characterize celiac disease in the elderly by comparing to a population of young adults with celiac disease.
Review of a tertiary center database of patients with celiac disease was performed to identify two groups of patients, an elderly cohort ≥65 years and a young adult cohort aged 18–30 years, with biopsy-confirmed celiac disease. Information obtained included symptom duration, clinical presentation, small intestinal pathology, associated conditions, and the presence of bone disease.
Included in the study were 149 young adult and 125 elderly patients; the latter represented 12.4% of the patients in our database. The duration of symptoms prior to diagnosis was similar, 5.8 ± 12 years and 6.14 ± 12.6 years in the young adult and elderly cohorts, respectively (p = 0.119). There was no significant difference in the mode of presentation of illness. Diarrhea was the main presenting symptom (49% in young adults vs. 50% in the elderly, p = 0.921). There was a similar prevalence of autoimmune disease (19% in young adults vs. 26% in the elderly, p = 0.133). Thyroid disease and neuropathy were more prevalent in the elderly (p = 0.037 and p = 0.023, respectively). The degree of villous atrophy and prevalence of bone disease were similar in each group.
Surprisingly, the presentation of celiac disease both clinically and histologically is similar in elderly and young adult patients. The factors triggering disease at any given age remain unclear and warrant further study.
- Green PH, Cellier C. Celiac disease. N Engl J Med. 2007;357:1731–1743. CrossRef
- Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003;163(3):286–292. CrossRef
- Cook HB, Burt MJ, Collett JA, et al. Adult coeliac disease: prevalence and clinical significance. J Gastroenterol Hepatol. 2000;15(9):1032–1036. CrossRef
- Baroni F, Ghisla MK, Leonardi R, Grassi V. Celiac disease in the elderly: a case report. Ann Ital Med Int. 2005;20(4):253–257.
- Freeman HJ. Adult celiac disease in the elderly. World J Gastroenterol. 2008;14(45):6911–6914. CrossRef
- Talal AH, Murray JA, Goeken JA, et al. Celiac disease in an adult population with insulin-dependent diabetes mellitus: use of endomysial antibody testing. Am J Gastroenterol. 1997;92(8):1280–1284.
- Counsell CE, Ruddell WS. Association between coeliac disease and autoimmune thyroid disease. Gut. 1995;36(3):475–476. CrossRef
- Rashtak S, Murray JA. Celiac disease in the elderly. Gastroenterol Clin N Am. 2009;38:433–446. CrossRef
- Hankey GL, Holmes GK. Coeliac disease in the elderly. Gut. 1994;35(1):65–67. CrossRef
- Johnson MW, Ellis HJ, Asante MA, Ciclitira PJ. Celiac disease in the elderly. Nat Clin Pract Gastroenterol Hepatol. 2008;5:697–706. CrossRef
- Lohi S, Mustalahti K, Kaukinen K, et al. Increasing prevalence of coeliac disease over time. Aliment Pharmacol Ther. 2007;26(9):1217–1225. CrossRef
- Marsh MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology. 1992;102:330–354.
- Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999;11:1185–1194. CrossRef
- West J, Logan RF, Hill PG, et al. Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut. 2003;52:960–965. CrossRef
- Bingley PJ, Williams AJ, Norcross AJ, Unsworth DJ, Lock RJ, Ness AR, Jones RW. Undiagnosed coeliac disease at age seven: population-based prospective birth cohort study. BMJ. 2004; 7:328(7435):322–323.
- Vilppula A, Kaukinen K, Luostarinen L, et al. Increasing prevalence and high incidence of celiac disease in elderly people: a population-based study. BMC Gastroenterol. 2009;9:49. CrossRef
- Collin P, Helin H, Maki M, Hallstrom O, Karvonen AL. Follow-up of patients positive in reticulin and gliadin antibody tests with normal small-bowel biopsy findings. Scand J Gastroenterol. 1993;28(7):595–598. CrossRef
- Marmouz F. Adult coeliac disease. Eur Ann Allergy Clin Immunol. 2007;39:23–25.
- Ivarsson A, Persson LA, Nystrom L, Hernell O. The Swedish coeliac disease epidemic with a prevailing twofold higher risk in girls compared to boys may reflect gender specific risk factors. Eur J Epidemiol. 2003;18:677–684. CrossRef
- Murray JA, Van Dyke C, Plevak MF, et al. Trends in the identification and clinical features of celiac disease in a North American community, 1950–2001. Clin Gastroenterol Hepatol. 2003;1(1):19–27. CrossRef
- Swinson CM, Levi AJ. Is coeliac disease underdiagnosed? Br Med J. 1980;281(6250):1258–1260. CrossRef
- Rubio-Tapia A, Kyle RA, Kaplan EL, Murray JA, et al. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology. 2009;137(1):88–93. CrossRef
- Jacobson DL, Gange SJ, Rose NR, Graham NM. Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clin Immunol Immunopathol. 1997;84:223–243. CrossRef
- Elfstrom P, Montgomery SM, Kampe O, et al. Risk of thyroid disease in individuals with celiac disease. J Clin Endocrinol Metabol. 2008;93(10):3915–3921. CrossRef
- Vanderpump MPJ, Tunbridge WMG, French JM, et al. The incidence of thyroid disorders in the community: a 20-year follow-up of the Whickham survey. Clin Endocrinol. 2005;43(1):55–68. CrossRef
- Sundbeck G, Lundberg PA, Lindstedt G, Jagenburg R, Eden S. Incidence and prevalence of thyroid disease in elderly women: results from the longitudinal population study of elderly people in Gothenburg, Sweden. Age Ageing. 1991;20:291–298. CrossRef
- Bemben DA, Winn P, Hamm RM, Morgan L, Davis A, Barton E. Thyroid disease in the elderly. Part 1. Prevalence of undiagnosed hypothyroidism. J Fam Pract. 1994;38:577–582.
- Bemben DA, Hamm RM, Morgan L, Winn P, Davis A, Barton E. Thyroid disease in the elderly. Part 2. Predictability of subclinical hypothyroidism. J Fam Pract. 1994;38:583–588.
- Muller GM, Levitt NS, Louw SJ. Thyroid dysfunction in the elderly. S Afr Med J. 1997;87:1119–1123.
- da Silva Kotze LM, Nisihara RM, da Rosa Utiyama SR, Piovezan GC, Kotze LR. Thyroid disorders in Brazilian patients with celiac disease. J Clin Gastroenterol. 2006;40:33–36. CrossRef
- Gawkrodger DJ, Blackwell JN, Gilmour HM, et al. Dermatitis herpetiformis: diagnosis, diet and demography. Gut. 1984;25(2):151–157. CrossRef
- Oxentenko AS, Murray JA. Celiac disease and dermatitis herpetiformis: the spectrum of gluten-sensitive enteropathy. Int J Dermatol. 2003;42:585–587. CrossRef
- Brar P, Kwon GY, Egbuna I, et al. Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease. Dig Liver Dis. 2007;39:26–29. CrossRef
- Murray JA, Rubio-Tapia A, Van Dyke CT, et al. Mucosal atrophy in celiac disease: extent of involvement, correlation with clinical presentation, and response to treatment. Clin Gastroenterol Hepatol. 2008;6:186–193. CrossRef
- Armagan O, Uz T, Tascioglu F, Colak O, Oner C, Akgun Y. Serological screening for celiac disease in premenopausal women with idiopathic osteoporosis. Clin Rheumatol. 2005;24:239–243. CrossRef
- Stenson WF, Newberry R, Lorenz R, Baldus C, Civitelli R. Increased prevalence of celiac disease and need for routine screening among patients with osteoporosis. Arch Intern Med. 2005;165:393–399. CrossRef
- Meyer D, Stavropolous S, Diamond B, Shane E, Green PH. Osteoporosis in a North American adult population with celiac disease. Am J Gastroenterol. 2001;96:112–119.
- Shaoul R, Lerner A. Associated autoantibodies in celiac disease. Autoimmune Rev. 2007;6(8):559–565. CrossRef
- Celiac Disease: Similar Presentations in the Elderly and Young Adults
Digestive Diseases and Sciences
Volume 55, Issue 11 , pp 3147-3153
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
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- Celiac disease
- Villous atrophy
- Bone disease
- Industry Sectors
- Author Affiliations
- 1. Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, 630 West 168th Street, PH20-312, Box 83, New York, NY, 10032, USA
- 2. Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, 630 West 168th Street, PH8-864, New York, NY, 10032, USA
- 3. Department of Pathology, Columbia University College of Physicians and Surgeons, 630 West 168th Street, VC-14-228, New York, NY, 10032, USA
- 4. Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
- 5. Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion-956, 180 Fort Washington Avenue, New York, NY, 10032, USA