Undetected coeliac disease in the elderly. A biopsy-proven population-based study

Department of Neurology, Päijät-Häme Central Hospital, Lahti, Finland.
Digestive and Liver Disease (Impact Factor: 2.96). 06/2008; 40(10):809-13. DOI: 10.1016/j.dld.2008.03.013
Source: PubMed


Up to 1% of the population suffer from coeliac disease. Data on the prevalence in elderly people is scant. We hypothesized that they would over time have developed obvious symptoms. Clinically silent or undiagnosed disease would thus be relatively uncommon.
To evaluate the prevalence of coeliac disease in elderly people.
The study comprised 2815 individuals aged 52-74 years. Clinical cases of coeliac disease were recorded. Sera from all subjects were screened by IgA class tissue transglutaminase antibodies, and seropositive underwent small bowel biopsy.
Coeliac disease was detected in altogether 60 individuals, in 25 (0.89%) on clinical grounds, and screening found in 35 (1.24%) new biopsy-proven cases. Thus, a total prevalence of 2.13% (95% confidence intervals 1.60-2.67%) was reached. Of the screen-detected cases, 15 had symptoms, albeit mostly mild. Two out of the 60 had small bowel T-cell lymphoma and two had gastric cancer. The total frequency of biopsy-proven coeliac disease and seropositive cases without histological confirmation was 2.45% (1.88-3.02%).
The prevalence of coeliac disease in elderly people was higher than what has been reported in the population in general. Active case finding by serologic screening is encouraged, since undetected cases may be prone to increased morbidity and mortality.

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    • "The prevalence of CD observed in our study was within the range of prevalence observed in studies in other Scandinavian and Northern European countries. A Finnish screening study found a serologically verified prevalence of 1740/ 100,000 and a biopsy verified prevalence of 1240/100,000 [9]. In a multicenter study from Finland, Germany, Italy, and Northern Ireland, based on screening studies of healthy adult populations, using an anti-TTG-assay, the following CD-prevalence was reported: Finland (serologically verified: 1870/100,000; biopsy-verified: 730/100,000), Germany (serologically verified: 430/100,000; biopsy-verified: "
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    ABSTRACT: Objective: The prevalence of celiac disease (CD) as recorded in the Danish National Patient Registry is ∼50/100,000 persons. This is much lower than the reported prevalence of CD in other Nordic countries and underdiagnosis is suspected. Our aim was to estimate the prevalence of CD in a population-based study of Danish adults. Methods: A total of 2297 adults aged 24-76 years living in the southwestern part of Copenhagen were screened for CD by immunoglobulin (Ig)A and IgG antibodies to transglutaminases and deamidated gliadin. IgA/IgG-positive participants were invited to a clinical evaluation, including biopsies, by a gastroenterologist. Results: Of the invited 56 participants, 40 underwent a full clinical evaluation and 8 persons were diagnosed with CD; 2 of the 16 persons, who did not complete the clinical evaluation, were considered by experts to have probable CD. None of the above 56 participants had a known history of CD or a recorded diagnosis of CD in National Patient Registry. By combining cases of biopsy-proven CD (n = 8), probable CD (n = 2), and registry-recorded CD (n = 1), the prevalence of CD was estimated to be 479/100,000 (11/2297) persons (95% CI: 197-761). Conclusion: In this general adult population, the prevalence of CD as estimated by screening and clinical evaluation was 10 times higher than the registry-based prevalence of CD. Of 11 participants diagnosed with CD in our screening study, 10 were unaware of the diagnosis prior to the study. Thus, our study suggests that CD is markedly underdiagnosed in Danish adults.
    Full-text · Article · Feb 2015 · Scandinavian Journal of Gastroenterology
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    • "Mortality has not increased among older undiagnosed celiac disease patients [6] and the effect of the diagnosis on well-being has not been investigated. In this prospective follow-up study we evaluated the consequences of dietary treatment in a definite celiac disease patient series obtained by population-based mass screening in the older [17]. Since neither celiac disease nor any abdominal disease was the target of the original GOAL project, there was no selection bias towards individuals suffering from gastrointestinal symptoms. "
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    ABSTRACT: The utility of serologic screening for celiac disease is still debatable. Evidence suggests that the disorder remains undetected even in the older population. It remains obscure whether screening makes good or harm in subjects with long-standing gluten ingestion. We evaluated whether older subjects benefit from active detection and subsequent gluten free dietary treatment of celiac disease. Thirty-five biopsy-proven patients aged over 50 years had been detected by serologic mass screening. We examined the disease history, dietary compliance, symptoms, quality of life and bone mineral density at baseline and 1-2 years after the commencement of a gluten-free diet. Symptoms were evaluated by gastrointestinal symptom rating scale and quality of life by psychological general well-being questionnaires. Small bowel biopsy, serology, laboratory parameters assessing malabsorption, and bone mineral density were investigated. Dietary compliance was good. The patients had initially low mean serum ferritin values indicating subclinical iron deficiency, which was restored by a gluten-free diet. Vitamin B12, vitamin D and erythrocyte folic acid levels increased significantly on diet. Celiac patients had a history of low-energy fractures more often than the background population, and the diet had a beneficial effect on bone mineral density. Alleviation in gastrointestinal symptoms was observed, even though the patients reported no or only subtle symptoms at diagnosis. Quality of life remained unchanged. Of all the cases, two thirds would have been diagnosed even without screening if the family history, fractures or concomitant autoimmune diseases had been taken carefully into account. Screen-detected patients benefited from a gluten-free diet. We encourage a high index of suspicion and active case-finding in celiac disease as an alternative to mass screening in older patients.
    Full-text · Article · Dec 2011 · BMC Gastroenterology
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    • "Using multiple terminology in defining atypical celiac disease (CD) has confused many of the clinicians to recognise atypical forms of this common disorder. CD is not considered an uncommon disorder any longer and is not a disease of essentially European origin (1). Nevertheless, recognising the existence of atypical forms known under the old terminologies like latent, silent and potential CD has introduced a new insight on clinical behaviour of this condition. "
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    ABSTRACT: Atypical presentation is the most common form of celiac disease (CD). Although the terminologies like latent, silent and potential have expressed different aspects of clinical and pathological behaviour of CD, they also have contributed in some extent to confusion between clinicians and patients due to the multiple definitions and uncertainty around them. In the light of new advances and the discovery of entities such as non-celiac gluten sensitivity, using subclinical instead of silent and atypical instead of potential/latent may simplify the understanding behind the clinical behaviour of atypical CD. The evidence behind a lower threshold for starting a gluten free diet (GFD) in non-celiac gluten sensitive patients would strongly support applying a GFD treatment strategy in any forms of CD.
    Full-text · Article · Mar 2011 · Gastroenterology and hepatology from bed to bench
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