Coeliac Disease in Elderly Patients

Abstract

Coeliac sprue is traditionally perceived as a disease related to early age, although young individuals may also suffer from typical bowel symptoms, which belong to the group of active coeliac syndromes. This opinion has been so far generally accepted by the medical public. Full-scale screening performed in the European countries and in the USA, however, has shown that the prevalence of this condition is about 1:100. It means that there are about 40,000–50,000 people affected by coeliac sprue in the Czech Republic, although currently the diagnosis has been established only in 15–20 % of the patients and the greater part of them remains undiagnosed. Thus, a majority of patients affected by coeliac disease are asymptomatic, oligosymptomatic, i.e. without typical intestinal symptoms of coeliac disease, and are therefore included in the category of atypical and silent coeliac disease (Table 21.1). This group comprises most adults without diagnosed coeliac disease. The most frequent atypical manifestation of the disease in adults and in the elderly is osteoporosis which, when combined in women with postmenopausal osteoporosis, may be difficult to treat. Therefore, attention should be paid to elderly patients with osteoporosis, where the incidence of coeliac disease may be expected in at least 3–6 % of patients.