Fewer Presenting with Classical Celiac Disease Symptoms

A team of researchers find the classical set of celiac disease symptoms no longer represents the profile of most newly-diagnosed patients, and physicians should consider other symptoms and the possibility of celiac disease even when patients don’t fit the “traditional” mold for the condition.

Umberto Volta, MD, director of the Celiac Disease and Malabsorption Syndrome Center, at St. Orsola-Malpighi Hospital, and colleagues studied 770 patients, 599 of whom were female, diagnosed with celiac disease between the years 1998 and 2007. Among these patients, nearly half were diagnosed within the first 10 years of the study period. The remaining patients were diagnosed in the last 5 years, which the authors say indicate a significant rise in the rates of diagnosis.
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Among all patients, 79% showed symptoms at the time of diagnosis, but most of the symptoms were “non-classical” symptoms such as bloating, osteoporosis, and anemia, as opposed to the typical diarrhea and weight loss. In fact, diarrhea was a symptom in just 27% of these patients

Classical symptoms were less common throughout the follow-up period, declining from 47% of patients during the first 10 years to 13% in the last five years. However, other issues as well as significant related illnesses, increased by more than 86%.

The findings demonstrate that celiac disease “can show up in many forms and at all ages,” says Volta, who urges primary care practitioners to be mindful that celiac disease is often associated with food intolerance, but is still underdiagnosed.

In order to bring out the “submerged iceberg of celiac disease,” serological tests such as anti-tissue transglutaminase and anti-endomysial antibodies should be used to investigate for the condition, not only in patients presenting with diarrhea, but in subjects complaining of constipation, bloating, alternate bowel habits, dyspepsia, iron-deficiency anemia, unexplained osteoporosis, abnormalities of liver function tests, recurrent miscarriages, aphthous stomatitis, and dental enamel defects, says Volta.

“Doctors must be aware how relevant it is to diagnose celiac disease,” he says, “since the treatment by gluten-free diet improves the quality of life in symptomatic patients and prevents complications in all celiac disease patients, including those without symptoms.”

—Mark McGraw

Reference

Volta U, Caio G, et al. The changing clinical profile of celiac disease: a 15-year experience (1998-2012) in an Italian referral center. BMC Gastroenterology. 2014.