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    New Study Sheds Light on Elderly Onset Celiac Disease


    Jefferson Adams
    Image Caption: Older people can show atypical signs of celiac disease. Photo: CC--Paul L. Dineen

    Celiac.com 09/28/2016 - Celiac disease occurs most often in children and young adults. However, people can develop celiac disease at any age, and rates are rising even among older people.


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    Because older people often show clinically atypical symptoms, they can sometimes experience a delay in diagnosis. Also, serological tests have a lower sensitivity and specificity in the older patients. This means that doctors only begin to suspect celiac disease in the presence of other, often vaguely associated complications, such as autoimmune disorders, fractures, and finally, malignancy, and that diagnosis must be aided by endoscopic and imaging tools.

    A team of researchers recently set out to assess the incidence and prevalence of celiac disease in the elderly, the patterns of clinical presentation, diagnosis, and the most frequent complications, with the aim of increasing awareness and reducing the diagnostic delay of celiac disease even in the elderly population.

    The research team included Maria Cappello, Gaetano C. Morreale, and Anna Licata of the Gastroenterology and Hepatology Section, DIBIMIS, University of Palermo School of Medicine, Palermo, Italy. The team's recent article highlights their findings regarding celiac rates and incidence in older patients, along with patterns of clinical presentation, diagnosis, and most frequent complications.

    The researchers conclude:

    "Despite a paucity of symptoms, such as diarrhea and weight loss, celiac disease has been increasingly recognized in the elderly. Other presentations in the elderly age group include iron deficiency anemia (often refractory to oral iron), autoimmune disorders, bone disease due to osteopenia, including fractures, malignant intestinal disease, especially lymphoma, and finally idiopathic dilated cardiomyopathy. Diagnosis may be delayed due to limited symptoms, a low index of clinical suspicion, or diagnostic difficulties related to important cognitive impairment that often affects elderly people. Although for these patients, the GFD is the key of clinical management, elderly patients sometimes are scarcely adherent to diet.


    Patients should be referred to specialists to ensure the better management of the disease and related complications. Micronutrients, such as iron, calcium, vitamin D supplementation, and vitamins, should be part of a modified GFD for the elderly patients. All other therapeutical interventions that limit malabsorption and avoid complications should be considered part of a management strategy."

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    I have celiac disease and have been on a gluten free diet for about 12 years. I had emails sent to me from BioTrust they tell you can take this pill and you can eat gluten it is Gluten Gaurd is this true or not. I've been told there is nothing you can take for celiac. Any feed back is welcome. Thank you for your time.

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    I have celiac disease and have been on a gluten free diet for about 12 years. I had emails sent to me from BioTrust they tell you can take this pill and you can eat gluten it is Gluten Gaurd is this true or not. I've been told there is nothing you can take for celiac. Any feed back is welcome. Thank you for your time.

    The only treatment for celiac disease is a gluten-free diet, but some digestive supplements could be helpful for those who do risk eating out.

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  • About Me

    Jefferson Adams is a freelance writer living in San Francisco. He has covered Health News for Examiner.com, and provided health and medical content for Sharecare.com. His work has appeared in Antioch Review, Blue Mesa Review, CALIBAN, Hayden's Ferry Review, Huffington Post, the Mississippi Review, and Slate, among others.

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  • Related Articles

    Scott Adams
    Please note that this study has no biopsy confirmation, so it can only be called gluten intolerance statistics. Its findings indicate that gluten intolerance may be relatively common in the general population.
    AU - Arnason JA ; Gudjonsson H ; Freysdottir J ; Jonsdottir I ; Valdimarsson H
    TI - Do Adults with High Gliadin Antibody Concentrations have Subclinical Gluten Intolerance?
    LA - Eng
    AD - Department of Immunology, National University Hospital, Reykjavik, Iceland.
    SO - Gut 1992 Feb;33(2):194-7 AB - Gliadin antibodies of the IgG and IgA isotopes and IgG subclasses were measured in 200 adults who were randomly selected from the Icelandic National Register.
    Those with the highest gliadin antibody concentrations were invited with negative controls to participate in a clinical evaluation. Neither the study subjects nor the physicians who recorded and evaluated the clinical findings were aware of the antibody levels. Significantly higher proportion of the gliadin antibody positive individuals reported unexplained attacks of diarrhea (p = 0.03), and IgA gliadin antibodies were associated with increased prevalence of chronic fatigue (p = 0.0037). The gliadin antibody positive group also showed significantly decreased transferrin saturation, mean corpuscular volume and mean corpuscular hemoglobin compared with the gliadin antibody negative controls. Serum folic acid concentrations were significantly lower in the IgA gliadin antibody positive individuals. On blind global assessment, 15 of the 48 participants were thought to have clinical and laboratory features that are compatible with gluten sensitive enteropathy, and 14 of these were in the gliadin antibody positive group (p = 0.013). Complaints that have not been associated with gluten intolerance had similar prevalence in both groups with the exception of persistent or recurrent headaches that were more common in the gliadin antibody positive group. These findings raise the possibility that a sub-clinical form of gluten intolerance may be relatively common.
    The following chart summarizes the study:
    No. Randomly Selected for Study No. Selected w/ High Gliadin No. w/ Gluten Sensitive Enteropathy No. w/ GSE & High Gliadin 200 ( = 100%) 48 ( = 24%) 15 ( = 7.5%) 14 ( = 7%)

    Jefferson Adams
    Celiac.com 06/13/2011 - Serological screening of asymptomatic people at risk for celiac disease is an effective method for spotting the disease and prompting early treatment, according to the results of a study by researchers from Finland, presented at Digestive Disease Week 2011.
    The study team showed that diagnosing and treating celiac disease in its earliest stages is beneficial in most screen-detected asymptomatic patients.
    Most of the patients the team studied were willing to continue on a gluten-free diet. On that basis, they assert that it is reasonable to screen at-risk groups.
    Lead author Kalle Kurppa, MD, from the University of Tampere in Finland noted that about 2% of the population has celiac disease, but that 90% of affected persons are never formally diagnosed.
    "Screening for celiac disease is problematic, and treatment is difficult. It is also unclear whether early diagnosis and treatment of screen-detected celiac disease is truly beneficial," Dr. Kurppa said.
    The study team set out to assess the benefit of adopting a gluten-free diet in asymptomatic adults with positive endomysial antibody (EmA) serological screens.
    For the study, the team recruited 3031 relatives of patients with celiac disease.  Of these, 148 showed positive EmA scans. 40 of these patients agreed to be randomly assigned to continue their gluten-containing diets (n = 20) , or to start a gluten-free diet (n = 20).
    In addition to screening for EmA testing, the study team tested for transglutaminase 2 antibodies, and surveyed patients using the Gastrointestinal Symptoms Rating Scale and Psychological General Well-Being instrument.
    The team evaluated laboratory parameters, celiac-specific genetics, bone mineral density, and body composition, along with small bowel mucosal morphology and inflammation.
    The team assessed patients at baseline and again after one year, at which time 18 of 20 control patients chose to begin the gluten-free diet as well.
    The team observed improvements in all patient parameters. The gluten-free diet group showed mucosal healing (changes in the villous height/crypt depth ratio); the control patients did not (P < .001).
    As senior investigator Katri Kaukinen, MD, PhD, explained in a press briefing: "After one year, those on a normal gluten diet had persistence or even a worsening of mucosal lesions, but those who started on a gluten-free diet showed recovery of the mucosa. The difference was really significant at one year."
    The group on the gluten-free diet also showed significantly reduced EmA titers (P < .001) and transglutaminase 2 antibody titers (P < .001) from baseline, along with improvements in symptoms (P < .001) and quality of life (P < .001), compared with the control patients.
    Control patients who switched to a gluten-free diet showed similar changes in all areas, except for quality of life after 1 year.
    Average laboratory readings, body mass index, and bone mineral density all registered within normal ranges at baseline, and showed no significant changes with the intervention. Also, folate and vitamin B12 levels showed substantial improvements on the gluten-free diet.
    Overall, patients had positive attitudes toward screening and the dietary intervention, Dr. Kurppa pointed out. Twenty-seven patients (67%) reported adherence to the gluten-free diet, 10 patients (25%) reported minor lapses, and only 3 patients (8%) reported a lack of adherence.
    Thirty-four patients (85%) were open to maintaining the gluten-free diet going forward.
    Five percent of patients found the gluten-free diet  'easy', Sixty-seven percent found it 'quite easy', while just thirteen percent of patients found if 'difficult.' Somehow, fifteen percent were "uncertain" about that question.
    Over half of the patients found the serological screening to be positive or very positive, and none found it to be a negative experience.
    Dr. Kaukinen noted at the press briefing that although patients first showed few, if any, symptoms, they reported feeling much better on the gluten-free diet.
    "We don't know why celiac patients have these different clinical phenotypes, why some get severe symptoms and others do not," said Kaukinen. It could be that people adapt to minor symptoms, and only realize their symptoms after they are gone. "Some patients told us they felt totally different on the diet," she added.
    Dr. Kaukinen says that the goal of early detection is to prevent worsening of symptoms, vitamin deficiencies, and possibly a loss in bone mineral density. "If we see early signs of disease, why should we wait when we can do something for them now?" she asked.
    Source:

    MedScape.com: Digestive Disease Week (DDW) 2011: Abstract 620. Presented May 9, 2011.

    Jefferson Adams
    Celiac.com 11/16/2011 - Researchers still don't know very much about the natural history of celiac disease and whether it may increase or decrease in prevalence over time.
    A research team recently set out to determine whether loss of tolerance to gluten may develop at any age, to investigate possible long-term changes in celiac disease prevalence, and to better understand other celiac-related issues.
    The research team consisted of C. Catassi, D. Kryszak, B. Bhatti, C. Sturgeon, K. Helzlsouer, S. L. Clipp, D. Gelfond, E. Puppa, A. Sferruzza, A. Fasano. They are affiliated with the Center for Celiac Research and Mucosal Biology Research Center at the University of Maryland School of Medicine in Baltimore.
    The team analyzed 3,511 subjects with matched samples from 1974 (CLUE I) and 1989 (CLUE II). For their study, the team chose and followed 3,511 subjects from two large groups of more than 20,000 Americans aged 13-80 in 1974 and 1989.  To see if there was an observable change in rates of celiac disease among the subjects over time, they took blood samples in 1974 and again 15 years later in 1989.
    They gave follow-up questionnaires to the subjects every 2 or 3 years from 1996 to 2007 to compile health status updates on the participants. Researchers conducted antibody testing on the blood samples. These tests showed just seven subjects with antibodies specific to celiac disease in 1974, for a disease rate of 1 in 501 subjects.
    By 1989, nine more samples showed markers for celiac disease, for a rate of 1 in 219 subjects; more than double the 1974 rate.
    The study also looked at another 804 samples from subjects who died after the 1974 survey and found two more likely cases of celiac disease.  To counter any selection bias regarding survival, the team also assessed 840 CLUE I participants who died after the 1974 survey.
    Since the individuals who provided the original samples did not undergo biopsy, and thus cases of celiac disease remain unconfirmed. Also, the study sample was not nationally representative by age, race, and gender, which may also have impacted the findings.
    The researchers state that this increase may be partly due to increased awareness of the disease. Still, many cases continue to go undiagnosed. In fact, only 11% of the study subjects who had celiac disease-specific antibodies in both the 1974 and 1989 surveys had actually been clinically diagnosed with the disease by their doctors.
    Also, the study found two subjects in their 50s who tested negative in 1974, but positive in 1989, when in their 60s. This indicates that the disease can strike at any age. This finding is supported by a study from Finland that found that celiac disease was more common among the elderly.
    Source:

    Ann Med. 2010 Oct;42(7):530-8.

    Jefferson Adams
    Celiac.com 03/02/2016 - A team of researchers recently completed the first extensive study comparing gene expression in children and adults with celiac disease, and found some key differences between the two groups.
    The research team included V. Pascual, L. M. Medrano , N. López-Palacios, A. Bodas, B. Dema, M. Fernández-Arquero, B. González-Pérez, I. Salazar, and C. Núñez. They are variously affiliated with Servicio de Pediatría, Servicio de Aparato Digestivo, and Servicio de Inmunología Clínica at the Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain, and with the Departamento de Producción Animal, Facultad de Veterinaria, and the Departamento de Estadística e Investigación Operativa I, Facultad de Matemáticas, Universidad Complutense de Madrid in Madrid, Spain.
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    The team used a Baysian methodology to analyze the differences of gene expression between groups. They found that, compared to controls, children and adults with celiac disease all had seven genes with a similarly altered expression. These were C2orf74, CCR6, FASLG, JAK2, IL23A, TAGAP and UBE2L3.
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    The team is calling for further research to assess possible genetic influences behind the changes, along with the specific physical consequences of the reported differences.
    Source:
    PLOS.ORG. Published: February 9, 2016. DOI: 10.1371/journal.pone.0146276

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    Celiac.com 06/19/2018 - Could baking soda help reduce the inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease? Scientists at the Medical College of Georgia at Augusta University say that a daily dose of baking soda may in fact help reduce inflammation and damage caused by autoimmune diseases like rheumatoid arthritis, and celiac disease.
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    The research was funded by the National Institutes of Health.
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    Jefferson Adams
    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
    The research team included P Singh, A Arora, TA Strand, DA Leffler, C Catassi, PH Green, CP Kelly, V Ahuja, and GK Makharia. They are variously affiliated with the Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Lady Hardinge Medical College, New Delhi, India; Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA; Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
    For their review, the team searched Medline, PubMed, and EMBASE for the keywords ‘celiac disease,’ ‘celiac,’ ‘tissue transglutaminase antibody,’ ‘anti-endomysium antibody,’ ‘endomysial antibody,’ and ‘prevalence’ for studies published from January 1991 through March 2016. 
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    Overall global prevalence of celiac disease was 1.4% in 275,818 individuals, based on positive blood tests for anti-tissue transglutaminase and/or anti-endomysial antibodies. The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% in 138,792 individuals. That means that numerous people with celiac disease potentially remain undiagnosed.
    Rates of celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was 0.6% in female vs 0.4% males. Celiac disease was significantly more common in children than adults.
    This systematic review and meta-analysis showed celiac disease to be reported worldwide. Blood test data shows celiac disease rate of 1.4%, while biopsy data shows 0.7%. The prevalence of celiac disease varies with sex, age, and location. 
    This review demonstrates a need for more comprehensive population-based studies of celiac disease in numerous countries.  The 1.4% rate indicates that there are 91.2 million people worldwide with celiac disease, and 3.9 million are in the U.S.A.
    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.