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  • Jefferson Adams
    Jefferson Adams

    Rates of Celiac Disease 2.5 Times Greater Among Elderly

    Celiac.com 10/10/2008 - A team of Finnish researchers announced that they have found high rates of undetected celiac disease in elderly populations. They have also noted that a significant number of those older people diagnosed with celiac disease showed only minor symptoms. The study team was made up of doctors A. Vilppula, P. Collin, M. M¨aki, R. Valve, M. Luostarinen, I. Krekel¨a, H. Patrikainen, K. Kaukinen, and L. Luostarinen.

    Even with a wealth of new information on celiac disease from numerous recent studies, along with better testing methods, we still don’t know very much about rates of celiac disease in older people.  Motivated by that fact, the team recently set out to study the prevalence of celiac disease in elderly populations.

    In theory, celiac disease should occur in the elderly at rates similar to, or lower than, those of the general population. Since current research indicates that about 1 person in a hundred has celiac disease, it seems logical to figure that rates of celiac disease among the elderly would be the same or even lower than rates for the general population.

    The researchers figured that clinically silent or undiagnosed celiac disease would be rare in elderly populations, as they would be likely to develop obvious symptoms. But the team was surprised to find that rates of celiac disease among the elderly are more than double those of the general population.
       
    They looked at 2,815 individuals between the ages of 52–74. They took blood samples from everyone and isolated people who showed signs of clinical celiac disease. They then screened the samples for IgA tissue transglutaminase antibodies. Subjects with positive antibody tests were given a small bowel biopsy. The doctors found celiac disease in 60 individuals, 25 (0.89%) through positive blood tests, and 35 (1.24%) through biopsy, for a total prevalence of in elderly subjects of 2.13% with 95% confidence intervals (1.60–2.67%). Of the screen-detected cases, only 15 had symptoms, and those were mostly mild. Driving home the dangers of late diagnosis, two out of the 60 had small bowel T-cell lymphoma and two had gastric cancer.

    Altogether, celiac disease was diagnosed through biopsy, and by blood test without a post-gluten-free diet follow-up test at a rate of 2.45% (1.88–3.02%).

    This study shows that celiac disease is far more prevalent in elderly people than in the general population.  To better detect and treat celiac disease in elderly populations, the doctors are encouraging the use of active case finding using blood tests, since undetected celiac disease can lead to serious complications and even early death.

    2008 Editrice Gastroenterologica Italiana S.r.l.


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    If this is replicated in other countries, it may suggest that the rate of celiac disease is higher than supposed - but that it can take years to get enough damage to show on tests. It would be interesting to know if there were other illnesses, e.g., dementia, showing higher rates amongst these until now undiagnosed celiacs. And if going gluten free helped the cases of cancer to slow their progressions.

    SandraB

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    Nothing surprising here. If you are young, you are diagnosed with colitis, or maybe IBS or Chron's. If you are older, they may call it Diverticulosis. My guess is that very few doctors have ever suggested that any elderly patient be tested for Celiac or go gluten-free.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Jefferson Adams
    Celiac.com 03/13/2009 - A recent study confirms that celiac disease affects adults with Turner Syndrome at rates of up to 5%, compared to 1% for the general population.
    A team of researchers recently set out to assess rates of celiac disease in adults with Turner Syndrome. Led by doctor A. Frost of the Department of Endocrinology at University College Hospital in London, UK, the research team included doctors M. Band, G. Conway.
    The researchers enlisted 256 adults with clinically proven Turner Syndrome. Five turned out to have existing diagnosis of celiac disease. The team conducted IgA endomysium antibody (EMA) screening for celiac disease on the remaining 251 Turner Syndrome patients.  Eight patients (3.2%) showed positive EMA screens. Doctors offered those eight patients endoscopy with duodenal biopsy.
    Seven patients committed to duodenal biopsy, and all seven (2.8%) showed positive histological confirmation for celiac disease. Thus, the doctors reasonably estimate the rate of sub-clinical celiac disease to be between 2.8% and 3.2%. When the existing cases are factored in, the total population shows rates between 4.7% and 5.1%.
    The team conducted human leukocyte antigen (HLA) typing in the existing celiac disease cases and new EMA-positive cases. Ten of those 13 patients submitted to HLA typing. Eight showed positive results for HLA-DQ2, one for HLA-DQ8, while one showed negative results for both HLA-DQ2 and HLA-DQ8.
    The study demonstrates that celiac disease affects adults with Turner Syndrome at rates of up to 5 times those of the general population, and the results are consistent with previous data published in pediatric populations.
    European Journal of Endocrinology. 2009 Feb 10


    Jefferson Adams
    Celiac.com 05/18/2009 - People with clinical irritable bowel syndrome (IBS) suffer from biopsy-proven celiac disease at rates that are more than four times higher than in non-IBS control subjects, according to the results of a recent systematic review and meta-analysis conducted by Alexander C. Ford, MBChB, MD, MRCP, from Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada, and colleagues.
    Prior studies have indicated that people with IBS had higher rates of celiac disease, but evidence has not been clear, and medical guidelines do not always call for celiac screening in these individuals.
    To determine rates of celiac disease in random adults meeting clinical criteria for IBS, the research team reviewed MEDLINE from 1950 to May 31, 2008, and EMBASE from 1980 to May 31, 2008. They isolated case series and case-control studies that contained data for celiac disease blood screens. They found 14 such studies.
    From each study, they isolated and aggregated positive serologic test results for celiac disease and biopsy-proved celiac disease. They then compared the data to that for patients with IBS and control individuals, using an odds ratio (OR) and 95% confidence interval (CI).
    The team isolated 4204 suitable cases from the identified studies. Of those, 2278 met clinical criteria for IBS (54%). The overall rate of positive immunoglobulin A (IgA)–class antigliadin antibodies (AGA) was 4.0% (95% CI, 1.7% – 7.2%), the rate of positive endomysial antibodies (EMA) was 1.63% (95% CI, 0.7% – 3.0%), and the rate of tissue transglutaminase (tTGA) was 4.1% (95% CI, 1.9% – 7.0%). For biopsy-proven celiac disease, the overall rate was 4.1% (95% CI, 1.9% – 7.0%).
    In patients who met the clinical criteria for IBS compared with non-IBS control subjects, aggregate OR for positive IgA-class antigliadin antibodies was 3.40 (95% CI, 1.62 – 7.13), aggregate OR for either positive EMA or tTGA was 2.94 (95% CI, 1.36 – 6.35), and aggregate OR for biopsy-proved celiac disease was 4.34 (95% CI, 1.78 – 10.6).
    The study did have some weaknesses, including issues with the methodology governing study selection, possible spectrum bias in case-control studies, possible selection bias in studies based in secondary care, and, in some cases, results too limited to allow meaningful aggregation of data.
    Still the research team concludes that rates of biopsy-proven celiac disease are more than four times higher for IBS patients than for non-IBS controls. The team recommends that, if screening is undertaken, EMA or tTGA testing be used in lieu of IgA-AGA testing due to their higher positive predictive value, though they admitted that results will depend on celiac rates in the population being screened.  
    The study was supported by the American College of Gastroenterology.

    Arch Intern Med. 2009;169:651–658.

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