Skip to main content
Top
Published in: Digestive Diseases and Sciences 11/2010

01-11-2010 | Original Article

Celiac Disease: Similar Presentations in the Elderly and Young Adults

Authors: Rupa Mukherjee, Ikenna Egbuna, Pardeep Brar, Lincoln Hernandez, Donald J. McMahon, Elizabeth J. Shane, Govind Bhagat, Peter H. R. Green

Published in: Digestive Diseases and Sciences | Issue 11/2010

Login to get access

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.
Literature
2.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
3.
go back to reference Cook HB, Burt MJ, Collett JA, et al. Adult coeliac disease: prevalence and clinical significance. J Gastroenterol Hepatol. 2000;15(9):1032–1036.CrossRefPubMed Cook HB, Burt MJ, Collett JA, et al. Adult coeliac disease: prevalence and clinical significance. J Gastroenterol Hepatol. 2000;15(9):1032–1036.CrossRefPubMed
4.
go back to reference 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.PubMed 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.PubMed
5.
6.
go back to reference 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.PubMed 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.PubMed
7.
go back to reference Counsell CE, Ruddell WS. Association between coeliac disease and autoimmune thyroid disease. Gut. 1995;36(3):475–476.CrossRefPubMed Counsell CE, Ruddell WS. Association between coeliac disease and autoimmune thyroid disease. Gut. 1995;36(3):475–476.CrossRefPubMed
8.
go back to reference Rashtak S, Murray JA. Celiac disease in the elderly. Gastroenterol Clin N Am. 2009;38:433–446.CrossRef Rashtak S, Murray JA. Celiac disease in the elderly. Gastroenterol Clin N Am. 2009;38:433–446.CrossRef
10.
go back to reference Johnson MW, Ellis HJ, Asante MA, Ciclitira PJ. Celiac disease in the elderly. Nat Clin Pract Gastroenterol Hepatol. 2008;5:697–706.CrossRefPubMed Johnson MW, Ellis HJ, Asante MA, Ciclitira PJ. Celiac disease in the elderly. Nat Clin Pract Gastroenterol Hepatol. 2008;5:697–706.CrossRefPubMed
11.
go back to reference Lohi S, Mustalahti K, Kaukinen K, et al. Increasing prevalence of coeliac disease over time. Aliment Pharmacol Ther. 2007;26(9):1217–1225.CrossRefPubMed Lohi S, Mustalahti K, Kaukinen K, et al. Increasing prevalence of coeliac disease over time. Aliment Pharmacol Ther. 2007;26(9):1217–1225.CrossRefPubMed
12.
go back to reference 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.PubMed 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.PubMed
13.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
14.
go back to reference West J, Logan RF, Hill PG, et al. Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut. 2003;52:960–965.CrossRefPubMed West J, Logan RF, Hill PG, et al. Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut. 2003;52:960–965.CrossRefPubMed
15.
go back to reference 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. 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.
16.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
17.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
18.
go back to reference Marmouz F. Adult coeliac disease. Eur Ann Allergy Clin Immunol. 2007;39:23–25.PubMed Marmouz F. Adult coeliac disease. Eur Ann Allergy Clin Immunol. 2007;39:23–25.PubMed
19.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
20.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
21.
22.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
23.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
24.
go back to reference 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.CrossRef 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.CrossRef
25.
go back to reference 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.CrossRef 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.CrossRef
26.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
27.
go back to reference 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.PubMed 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.PubMed
28.
go back to reference 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.PubMed 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.PubMed
29.
go back to reference Muller GM, Levitt NS, Louw SJ. Thyroid dysfunction in the elderly. S Afr Med J. 1997;87:1119–1123.PubMed Muller GM, Levitt NS, Louw SJ. Thyroid dysfunction in the elderly. S Afr Med J. 1997;87:1119–1123.PubMed
30.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
31.
go back to reference Gawkrodger DJ, Blackwell JN, Gilmour HM, et al. Dermatitis herpetiformis: diagnosis, diet and demography. Gut. 1984;25(2):151–157.CrossRefPubMed Gawkrodger DJ, Blackwell JN, Gilmour HM, et al. Dermatitis herpetiformis: diagnosis, diet and demography. Gut. 1984;25(2):151–157.CrossRefPubMed
32.
go back to reference Oxentenko AS, Murray JA. Celiac disease and dermatitis herpetiformis: the spectrum of gluten-sensitive enteropathy. Int J Dermatol. 2003;42:585–587.CrossRefPubMed Oxentenko AS, Murray JA. Celiac disease and dermatitis herpetiformis: the spectrum of gluten-sensitive enteropathy. Int J Dermatol. 2003;42:585–587.CrossRefPubMed
33.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
34.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
35.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
36.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
37.
go back to reference 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.PubMed 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.PubMed
38.
go back to reference Shaoul R, Lerner A. Associated autoantibodies in celiac disease. Autoimmune Rev. 2007;6(8):559–565.CrossRef Shaoul R, Lerner A. Associated autoantibodies in celiac disease. Autoimmune Rev. 2007;6(8):559–565.CrossRef
Metadata
Title
Celiac Disease: Similar Presentations in the Elderly and Young Adults
Authors
Rupa Mukherjee
Ikenna Egbuna
Pardeep Brar
Lincoln Hernandez
Donald J. McMahon
Elizabeth J. Shane
Govind Bhagat
Peter H. R. Green
Publication date
01-11-2010
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 11/2010
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-010-1142-4

Other articles of this Issue 11/2010

Digestive Diseases and Sciences 11/2010 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.