Digestive Diseases and Sciences

, Volume 48, Issue 2, pp 395–398 | Cite as

Changing Presentation of Adult Celiac Disease

  • Winson Lo
  • Kevin Sano
  • Ben Lebwohl
  • Beverly Diamond
  • Peter H.R. Green


The mode of presentation of celiac disease in the United States is not known. We investigated the demographic and clinical features of 227 patients with biopsy-proven celiac disease and determined if there had been changes over time. The patients had been entered into a database; those seen prior to 1990 were retrospectively entered while those seen subsequently were prospectively entered. A “symptomatic” presentation described the “classical” presentation of celiac disease with prominent gastrointestinal symptoms: diarrhea and weight loss. Females were younger and had a longer duration of symptoms compared to males. The modes of presentation were symptomatic (62%), anemia or reduced bone density (15%), screening first-degree relatives (13%), and incidental diagnosis at endoscopy (8%). We compared those diagnosed before and after 1993 (when serologic testing was first used), and noted a reduction in those presenting with diarrhea, 73% vs 43% (P = 0.0001) and a reduction in the duration of symptoms, from 9.0 ± 1.1 years to 4.4 ± 0.6 years (P < 0001). In conclusion, the percentage of celiac disease patients presenting with diarrhea has decreased, probably related to the more widespread use of serologic testing for celiac disease.

celiac disease presentation epidemiology diarrhea 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Green PHR, Stavropoulos SN, Panagi SG, Goldstein SL, McMahon DJ, Absan H, Neugut AI: Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol 96:126-131, 2001Google Scholar
  2. 2.
    Logan RF, Tucker G, Rifkind EA, Heading RC, Ferguson A: Changes in clinical features of coeliac disease in adults in Edinburgh and the Lothians 1960–79. Br Med J (Clin Res Ed). 286:95-97, 1983Google Scholar
  3. 3.
    Swinson CM, Levi AJ: Is coeliac disease underdiagnosed? Br Med J 281:1258-1260, 1980Google Scholar
  4. 4.
    Pare P, Douville P, Caron D, Lagace R: Adult celiac sprue: changes in the pattern of clinical recognition. J Clin Gastroenterol 10:395-400, 1988Google Scholar
  5. 5.
    Campbell CB, Roberts RK, Cowen AE: The changing clinical presentation of coeliac disease in adults. Med J Aust 1:89-93, 1977Google Scholar
  6. 6.
    Ciacci C, Cirillo M, Sollazzo R, Savino G, Sabbatini F, Mazzacca G: Gender and clinical presentation in adult celiac disease. Scand J Gastroenterol 30:1077-1081, 1995Google Scholar
  7. 7.
    Ferguson A, Arranz E, O'Mahony S: Clinical and pathological spectrum of coeliac disease—active, silent, latent, potential. Gut. 34:150-151, 1993Google Scholar
  8. 8.
    Talley NJ, Valdovinos M, Petterson TM, Carpenter HA, Melton LJ 3rd: Epidemiology of celiac sprue: a community-based study. Am J Gastroenterol 89:843-846, 1994Google Scholar
  9. 9.
    Farrell RJ, Kelly CP: Celiac sprue. N Engl J Med 346:180-188, 2002Google Scholar
  10. 10.
    Murray JA: Serodiagnosis of celiac disease. Clin Lab Med 17:445-464, 1997Google Scholar
  11. 11.
    Walker-Smith JA GS, Schmerling DM, Visakorpi JK: Revised criteria for diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition. Arch Dis Child. 65:909-911, 1990Google Scholar
  12. 12.
    Green PA, Wollaeger EE: The clinical behavior of sprue in the United States. Gastroenterology 38:399-418, 1960Google Scholar
  13. 13.
    Mann JG, Brown WR, Kern F Jr.: The subtle and variable clinical expressions of gluten-induced enteropathy (adult celiac disease, nontropical sprue). An analysis of twenty-one consecutive cases. Am J Med 48:357-366, 1970Google Scholar
  14. 14.
    Dickey W, McConnell JB: How many hospital visits does it take before celiac sprue is diagnosed? J Clin Gastroenterol. 23:21-23, 1996Google Scholar
  15. 15.
    Cooper BT: The delayed diagnosis of coeliac disease. NZ Med J 99:543-545, 1986Google Scholar
  16. 16.
    Lankisch PG, Martinez Schramm A, Petersen F, Droge M, Lehnick D, Lembcke B: Diagnostic intervals for recognizing celiac disease. Z Gastroenterol 34:473-477, 1996Google Scholar
  17. 17.
    Marsh MN: Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue'). Gastroenterology 102:330-354, 1992Google Scholar
  18. 18.
    Berti I HK, Green PH, Not T, Garafolo B, Fasano A: Prevelence of celiac disease among first and second-degree relatives in the USA. Gastroenterology 116:A861, 1999Google Scholar
  19. 19.
    Ventura A, Magazzu G, Greco L: Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Gastroenterology 117(2):297-303, 1999Google Scholar
  20. 20.
    Toscano V, Conti FG, Anastasi E, Mariani P, Tiberti C, Poggi M, Montuori M, Monti S, Laureti S, Cipolletta K, Gemme G, Caiola S, Di Mario V, Bon Amico M: Importance of gluten in the induction of endocrine autoantibodies and organ dysfunction in adolescent celiac patients. Am J Gastroenterol 95(7):1742-1748, 2000Google Scholar
  21. 21.
    Green PH, Shane E, Rotterdam H, Forde KA, Grossbard L: Significance of unsuspected celiac disease detected at endoscopy. Gastrointest Endosc 51:60-65, 2000Google Scholar
  22. 22.
    Usai P, Bassotti G, Usai Satta P, Cherchi M, Plesa A, Boy F, Morelli A, Balestrieri A: Oesophageal motility in adult coeliac disease. Neurogastroenterol Motil 7:239-244, 1995Google Scholar
  23. 23.
    Shah VH, Rotterdam H, Kotler DP, Fasano A, Green PH: All that scallops is not celiac disease. Gastrointest Endosc 51:717-720, 2000Google Scholar
  24. 24.
    Oxentenko AS, Grisolano SW, Murray JA, Burgart LJ, Dierkhising RA, Alexander JA: The insensitivity of endoscopic markers in celiac disease. Am J Gastroenterol 97:933-938, 2002Google Scholar
  25. 25.
    Not T, Horvath K, Hill ID, Partanen J, Hammed A, Magazzu G, Fasano A: Celiac disease risk in the USA: high prevalence of antiendomysium antibodies in healthy blood donors. Scand J Gastroenterol 33:494-498, 1998Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  • Winson Lo
    • 1
  • Kevin Sano
    • 1
  • Ben Lebwohl
    • 1
  • Beverly Diamond
    • 1
  • Peter H.R. Green
    • 1
  1. 1.Department of MedicineColumbia University College of Physicians and Surgeons, New YorkNew YorkUSA

Personalised recommendations