Celiac.com 03/07/2016 - Even though doctors know a lot more about celiac disease than they did just a few years ago, and even though they are learning more all the time, there are still very few detailed clinical descriptions of large groups of celiac patients.

Photo: CC--Roman BoedRecently, a team of researchers reviewed a large Dutch cohort of celiac patients to create an overview that focused on symptom presentation, co-occurrence of immune mediated diseases and malignancies.

The research team included M Spijkerman, IL Tan, JJ Kolkman, S Withoff, C Wijmenga, MC Visschedijk, and RK Weersma. They are variously associated with the Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen; the Department of Genetics, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands, and with the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands.

To create their overview, the team performed a retrospective study in a Dutch university and a non-university medical hospital that included only patients with biopsy proven (≥Marsh type 2 classification) celiac disease.

The team selected 412 patients from 9,468 small-bowel biopsy pathology reports and financial codes. About a third of the group showed classical celiac symptoms, including diarrhea (37.4%), fatigue (35.0%), weight loss (31.6%), abdominal pain (33.3%).

Around 10% showed atypical symptoms, including constipation (10.4%) and reflux (12.4%), while nearly 12% were diagnosed without any reported symptoms.

About one in four patients also had immune-mediated diseases, most commonly type 1 diabetes mellitus (4.9%), microscopic colitis (4.9%), and immune mediated-thyroid disease (4.1%). Celiac patients who also had immune-mediated diseases were significantly older at the time of diagnosis, compared to those without (P=0.002).

A total of 53 patients (12.9%) had malignancies, eight of whom suffered from Enteropathy Associated T-cell Lymphomas.

This is the first Dutch study to describe a group of celiac patients in such detail. The study highlights the wide range of clinical variables in celiac disease, as well as the importance of screening for celiac patients for concomitant diseases.


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