More and more people with celiac disease present atypical symptoms that are clinically indistinguishable from other gastrointestinal disorders. A new study shows that upwards of 4% of people with generalized gastrointestinal complaints  show elevated celiac disease antibodies when screened.

A team of researchers recently set out to assess rates of celiac disease in patients with gastrointestinal symptoms, and to catalog the common manifestations of atypical expressions of celiac disease. The research team was made up of Mohammad Rostami Nejad, Kamran Rostami, Mohamad Amin Pourhoseingholi, Ehsan Nazemalhosseini Mojarad, Manijeh Habibi, Hossein Dabiri, and Mohammad Reza Zali.

The team designed and executed a cross sectional study that included 5,176 individuals chosen randomly from self-referred patients within a primary care setting in Tehran province from 2006-2007.

In all, 670 of the 5176, or 13% of patients self-referred to a general practitioner suffered from gastrointestinal complaints.  All 670 subjects with gastrointestinal symptoms underwent celiac blood tests, including total immunoglobulin A (IgA) and anti-tissue transglutaminase (tTG) antibodies. Individuals showing IgA deficiency underwent screening for IgG tTG.

Of the 670 investigated for gastrointestinal complaints, a total of 22 patients, 17 women and 5 men, showed positive anti-tTG results (95% CI: 1.70-4.30). Another 8/670 showed IgA deficiency, with 3 of those 8 subjects showing positive IgG tTG.  Dyspepsia (indigestion) was the chief complaint in 25 patients with positive blood tests and cases that were analogous to the rest of the subjects.

In all, 3.3% of serologically screened samples excluding IgA-deficient showed celiac disease antibodies, compared to 3.7% of those IgA-deficient subjects with positive tTG-IgG.

Generalized gastrointestinal complaints are a common indication of atypical celiac disease. This study points to high rates of celiac disease antibodies among patients with generalized gastrointestinal symptoms (3.7%).

Clinicians and patients will benefit from greater vigilance regarding atypical presentation of celiac disease and its association with generalized gastrointestinal symptoms.

Source:
Journal of Gastrointestinal Liver Disease - September 2009 Vol.18 No 3, 285-291

As always, Celiac.com welcomes your comments (see below).