Digestive Diseases and Sciences

, Volume 55, Issue 11, pp 3147–3153 | Cite as

Celiac Disease: Similar Presentations in the Elderly and Young Adults

  • Rupa Mukherjee
  • Ikenna Egbuna
  • Pardeep Brar
  • Lincoln Hernandez
  • Donald J. McMahon
  • Elizabeth J. Shane
  • Govind Bhagat
  • Peter H. R. Green
Original Article

Abstract

Background/Aims

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Celiac disease Elderly Villous atrophy Bone disease 

References

  1. 1.
    Green PH, Cellier C. Celiac disease. N Engl J Med. 2007;357:1731–1743.CrossRefPubMedGoogle Scholar
  2. 2.
    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.CrossRefPubMedGoogle Scholar
  3. 3.
    Cook HB, Burt MJ, Collett JA, et al. Adult coeliac disease: prevalence and clinical significance. J Gastroenterol Hepatol. 2000;15(9):1032–1036.CrossRefPubMedGoogle Scholar
  4. 4.
    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.PubMedGoogle Scholar
  5. 5.
    Freeman HJ. Adult celiac disease in the elderly. World J Gastroenterol. 2008;14(45):6911–6914.CrossRefPubMedGoogle Scholar
  6. 6.
    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.PubMedGoogle Scholar
  7. 7.
    Counsell CE, Ruddell WS. Association between coeliac disease and autoimmune thyroid disease. Gut. 1995;36(3):475–476.CrossRefPubMedGoogle Scholar
  8. 8.
    Rashtak S, Murray JA. Celiac disease in the elderly. Gastroenterol Clin N Am. 2009;38:433–446.CrossRefGoogle Scholar
  9. 9.
    Hankey GL, Holmes GK. Coeliac disease in the elderly. Gut. 1994;35(1):65–67.CrossRefPubMedGoogle Scholar
  10. 10.
    Johnson MW, Ellis HJ, Asante MA, Ciclitira PJ. Celiac disease in the elderly. Nat Clin Pract Gastroenterol Hepatol. 2008;5:697–706.CrossRefPubMedGoogle Scholar
  11. 11.
    Lohi S, Mustalahti K, Kaukinen K, et al. Increasing prevalence of coeliac disease over time. Aliment Pharmacol Ther. 2007;26(9):1217–1225.CrossRefPubMedGoogle Scholar
  12. 12.
    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.PubMedGoogle Scholar
  13. 13.
    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.CrossRefPubMedGoogle Scholar
  14. 14.
    West J, Logan RF, Hill PG, et al. Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut. 2003;52:960–965.CrossRefPubMedGoogle Scholar
  15. 15.
    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.Google Scholar
  16. 16.
    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.CrossRefPubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    Marmouz F. Adult coeliac disease. Eur Ann Allergy Clin Immunol. 2007;39:23–25.PubMedGoogle Scholar
  19. 19.
    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.CrossRefPubMedGoogle Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    Swinson CM, Levi AJ. Is coeliac disease underdiagnosed? Br Med J. 1980;281(6250):1258–1260.CrossRefPubMedGoogle Scholar
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    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.CrossRefPubMedGoogle Scholar
  24. 24.
    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.CrossRefGoogle Scholar
  25. 25.
    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.CrossRefGoogle Scholar
  26. 26.
    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.CrossRefPubMedGoogle Scholar
  27. 27.
    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.PubMedGoogle Scholar
  28. 28.
    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.PubMedGoogle Scholar
  29. 29.
    Muller GM, Levitt NS, Louw SJ. Thyroid dysfunction in the elderly. S Afr Med J. 1997;87:1119–1123.PubMedGoogle Scholar
  30. 30.
    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.CrossRefPubMedGoogle Scholar
  31. 31.
    Gawkrodger DJ, Blackwell JN, Gilmour HM, et al. Dermatitis herpetiformis: diagnosis, diet and demography. Gut. 1984;25(2):151–157.CrossRefPubMedGoogle Scholar
  32. 32.
    Oxentenko AS, Murray JA. Celiac disease and dermatitis herpetiformis: the spectrum of gluten-sensitive enteropathy. Int J Dermatol. 2003;42:585–587.CrossRefPubMedGoogle Scholar
  33. 33.
    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.CrossRefPubMedGoogle Scholar
  34. 34.
    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.CrossRefPubMedGoogle Scholar
  35. 35.
    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.CrossRefPubMedGoogle Scholar
  36. 36.
    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.CrossRefPubMedGoogle Scholar
  37. 37.
    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.PubMedGoogle Scholar
  38. 38.
    Shaoul R, Lerner A. Associated autoantibodies in celiac disease. Autoimmune Rev. 2007;6(8):559–565.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Rupa Mukherjee
    • 1
  • Ikenna Egbuna
    • 1
  • Pardeep Brar
    • 1
  • Lincoln Hernandez
    • 1
  • Donald J. McMahon
    • 2
  • Elizabeth J. Shane
    • 2
  • Govind Bhagat
    • 3
  • Peter H. R. Green
    • 4
    • 5
  1. 1.Division of Digestive and Liver Diseases, Department of MedicineColumbia University College of Physicians and SurgeonsNew YorkUSA
  2. 2.Division of Endocrinology, Department of MedicineColumbia University College of Physicians and SurgeonsNew YorkUSA
  3. 3.Department of PathologyColumbia University College of Physicians and SurgeonsNew YorkUSA
  4. 4.Department of MedicineColumbia University College of Physicians and SurgeonsNew YorkUSA
  5. 5.Celiac Disease Center, Columbia University Medical CenterNew YorkUSA

Personalised recommendations