Alimentary Tract
Undetected coeliac disease in the elderly: A biopsy-proven population-based study

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Abstract

Background

Up to 1% of the population suffer from coeliac disease. Data on the prevalence in elderly people is scant. We hypothesized that they would over time have developed obvious symptoms. Clinically silent or undiagnosed disease would thus be relatively uncommon.

Aims

To evaluate the prevalence of coeliac disease in elderly people.

Methods

The study comprised 2815 individuals aged 52–74 years. Clinical cases of coeliac disease were recorded. Sera from all subjects were screened by IgA class tissue transglutaminase antibodies, and seropositive underwent small bowel biopsy.

Results

Coeliac disease was detected in altogether 60 individuals, in 25 (0.89%) on clinical grounds, and screening found in 35 (1.24%) new biopsy-proven cases. Thus, a total prevalence of 2.13% (95% confidence intervals 1.60–2.67%) was reached. Of the screen-detected cases, 15 had symptoms, albeit mostly mild. Two out of the 60 had small bowel T-cell lymphoma and two had gastric cancer. The total frequency of biopsy-proven coeliac disease and seropositive cases without histological confirmation was 2.45% (1.88–3.02%).

Conclusion

The prevalence of coeliac disease in elderly people was higher than what has been reported in the population in general. Active case finding by serologic screening is encouraged, since undetected cases may be prone to increased morbidity and mortality.

Introduction

The classical symptoms of coeliac disease comprise diarrhoea, steatorrhoea, weight loss and malabsorption syndrome. Because of better recognition of the disease, the clinical pattern has changed. Patients may have mild abdominal discomfort, occasional diarrhoea, or isolated, subclinical malabsorption [1]. Many, if not most, patients do not have significant gastrointestinal symptoms or any at all. Symptoms may also occur outside the gastrointestinal tract, dermatitis herpetiformis being the best-known condition. Without obvious symptoms coeliac disease often remains unrecognized. Serologic screening studies have shown that the prevalence of the disease in the population is 0.3–1% [2], [3], [4], but the number of detected cases is much lower.

The delay in diagnosis of coeliac disease in elderly patients is evidently long, and elderly people may often suffer from classical symptoms [5]. Consequently, the clinical diagnosis should be easier and undetected cases less common than in young people. However, data on the frequency of detected and undiagnosed coeliac disease in the elderly are sparse. This was investigated in a population-based cohort aged 52 years or more, as a part of a research and development project among ageing people in a well-defined area.

Section snippets

Subjects and methods

The study population comprised 4272 randomly selected individuals born in the years 1946–1950, 1936–1940 and 1926–1930 and living in the Päijät-Häme Hospital district; the study sample was representative of the general population in the respective age groups. The data were collected for a research project on Ageing and well-being (Good Ageing in the Lahti region = GOAL). Its primary target was to improve health and well-being in the ageing population. Patient recruitment and serum sampling took

The prevalence of coeliac disease

Altogether 2815 (66%) out of 4242 individuals consented to participate in the original GOAL study (Table 1). Coeliac disease had previously been established on clinical grounds in 25 (0.89%) out of the 2815 subjects, six of them also having dermatitis herpetiformis. Four of the 25 had been detected due to symptoms between sampling (in 2002) and analysis (in 2004) of sera, and had thus been on a normal diet when the sera were drawn. All fulfilled the current diagnostic criteria. It was possible

Discussion

The frequency of biopsy-proven coeliac disease in patients over 50 years of age was 2.1%, the corresponding percentages in Finnish and Estonia children being 1.0% and 0.34%, respectively [2], [9]. The prevalence of clinically detected cases in our series was 0.89%. This is almost two times higher than that (0.45%) in our adult population [10], and comparable to the percentages achieved in serologic screening studies [2], [3], [4].

Earlier coeliac disease was regarded as a condition affecting

Conflict of interest statement

None declared

Acknowledgements

This study was supported by the Competitive Research Funding of the Pirkanmaa Hospital District and Päijät-Häme Central Hospital, and the Academy of Finland. We thank the study nurse Seija Takala for contacting the patients and collecting the data.

References (21)

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