Age-related differences in celiac disease: Specific characteristics of adult presentation

Vivas, Santiago; Vaquero, Luis; Rodríguez-Martín, Laura; Caminero, Alberto

doi:10.4292/wjgpt.v6.i4.207

Cited by 47 publications

(61 citation statements)

References 40 publications

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“…In the study of Vivas et al, typical symptoms were present in 62.5% children vs 31% in adults ( P = 0.01). The average time to diagnosis after the appearance of symptoms was 7.6 months for children and 90 months for adults ( P < 0.001).…”

Section: Clinical Manifestationsmentioning

confidence: 87%

Review article: coeliac disease in later life must not be missed

Collin

Vilppula

Luostarinen

et al. 2018

Aliment Pharmacol Ther

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SummaryBackground: The presenting symptoms of coeliac disease are often subtle and the diagnosis is frequently delayed or overlooked. Therefore, especially elderly patients may be denied the benefits conferred by gluten free diet which can be dramatically life-changing.Aim: To review the occurrence, clinical features, diagnosis and management in coeliac patients detected later in life.Methods: To review manuscripts concerned with coeliac disease in the elderly and to derive subgroups of elderly people from publications on the disorder.Results: Approximately a quarter of all diagnoses are now made at the age of 60 years or more and a fifth at 65 years or over. About 4% are diagnosed at 80 years or above. Around 60% remain undetected, since their symptoms are often subtle: tiredness, indigestion, reduced appetite. Good compliance with gluten free diet, resolution of symptoms and improvement in laboratory indices can be achieved in over 90% of patients.Conclusions: Coeliac disease not uncommonly presents for the first time in older patients and is an important diagnosis to make.

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Section: Clinical Manifestationsmentioning

confidence: 87%

Review article: coeliac disease in later life must not be missed

Collin

Vilppula

Luostarinen

et al. 2018

Aliment Pharmacol Ther

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“…The serologic tests are for IgA antibodies to endomysium (EMA) and tissue transglutaminase (tTG), which have very high sensitivity and specificity, close to 100% (Table ). The titers of these antibodies are usually much higher and more reliable in children than in adults . IgA and IgG antibodies to deamidated gliadin peptide (DGP) are also highly reliable and can be used in young children or IgA‐deficient patients.…”

Section: Celiac Diseasementioning

confidence: 99%

“…Histologic characteristics of CD include villous atrophy, elongated crypts, increased mitotic index in the crypts, increased intraepithelial lymphocytes (IELs), cellular infiltrate in the lamina propria (plasma cell, lymphocytes, mast cells, eosinophils, and basophils), and cuboidal pseudostratified epithelium. Four findings (IEL in duodenum, IEL in jejunum, crypt hyperplasia, and villous damage) are used for the Marsh‐Oberhuber classification of the disease severity, which tends to be worse in children than in adults . Interestingly, negative serologic tests occur in approximately 15%‐20% of patients with significant villous atrophy …”

Section: Celiac Diseasementioning

confidence: 99%

Gluten sensitivities and the allergist: Threshing the grain from the husks

Burkhardt

Chapa-Rodríguez

Bahna

2017

Allergy

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Abstract"Gluten sensitivity" has become commonplace among the public. Wheat allergy (WA) and celiac disease (CD) are well-defined entities, but are becoming a fraction of individuals following a gluten-free diet (GFD). Wheat allergy has a prevalence of <0.5%. Wheat, specifically its omega-5 gliadin fraction, is the most common allergen implicated in food-dependent, exercise-induced anaphylaxis. CD is a non-IgE hypersensitivity to certain cereal proteins: gluten in wheat, secalin in rye, hordein in barley, and to a lesser extent avenin in oat. It is a rare disease, with an estimated prevalence that varied widely geographically, being higher in Northern Europe and the African Saharawi region than in South-East Asia. In addition to suggestive symptoms, serologic testing has high diagnostic reliability and biopsy is a confirmatory procedure. Patients with CD have extra-intestinal autoimmune comorbid conditions more frequently than expected. A third entity is nonceliac gluten sensitivity, which has been created because of the increasing number of subjects who claim a better quality of life or improvement of their variety of symptoms on switching to a GFD.The phenomenon is being fueled by the media and exploited by the industry. The lack of a specific objective test has been raising substantial controversy about this entity. Allergists and gastroenterologists need to pay attention to the multitudes of individuals who elect to follow a GFD. Many such subjects might have WA, CD, or another illness. Providing them with appropriate evaluation and specific management would be of great advantages, medically and economically. K E Y W O R D Sceliac disease, gluten sensitivity, gluten-free diet, nonceliac gluten sensitivity, wheat allergy 1 | INTRODUCTION "Gluten" has become part of everyday vocabulary by the public, a popular topic by the media, and is being exploited by the food industry. Three wheat-related disorders have been described, namely wheat allergy (WA), celiac disease (CD), and the new entity nonceliac gluten sensitivity (NCGS). The objective of this paper was to differentiate between these 3 disorders regarding epidemiology, manifestations, pathogenesis, diagnosis, and management. As a timely topic, "gluten sensitivity" stimulated the publication of multiple reviews, mainly in the gastroenterology and nutrition literatures, but not so in the allergy literature. Fueled by the media and the food industry's promotion of gluten-free products, the number of subjects claiming gluten-related illnesses has been exponentially increasing and they are seeking or referred for allergy evaluation.

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“…The clinical manifestations may vary depending on the age of presentation, duration of disease, amount of gluten in diet, presence of other auto immune diseases [19]. Children less than 2 years present primarily with symptoms like diarrhea, vomiting, malnutrition, abdominal bloating and anemia, whereas older children present with loose stools, growth delay, pubertal delay and so on [20]. Usually when some autoimmune disease is associated with celiac disease, like diabetes mellitus, CD is often silent and is recognized only after serological screening for CD in these patients after the autoimmune disease has been recognized [21].…”

Section: Clinical Featuresmentioning

confidence: 99%

Immunopathogenesis and therapeutic approaches in pediatric celiac disease

Agarwal

Kovilam

Zach

et al. 2016

Expert Review of Clinical Immunology

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Summary Celiac Disease is an autoimmune enteropathy with increasing incidence worldwide in both adults and children. It occurs as an inflammatory condition with destruction of the normal architecture of villi on consumption of gluten and related protein products found in wheat, barley and rye. However, the exact pathogenesis is not yet fully understood. A gluten-free diet remains the main modality of therapy to date. While some patients continue to have symptoms even on a gluten-free diet, adherence to this diet is also difficult, especially for the children. Hence, there is continued interest in novel methods of therapy and the current research focus is on the promising novel non-dietary modalities of treatment. Here, we critically reviewed the existing literature regarding the pathogenesis of celiac disease in children including the role of in-utero exposure leading to neonatal and infant sensitization and its application for the development of new therapeutic approaches for these patients.

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Age-related differences in celiac disease: Specific characteristics of adult presentation

Cited by 47 publications

References 40 publications

Review article: coeliac disease in later life must not be missed

Review article: coeliac disease in later life must not be missed

Gluten sensitivities and the allergist: Threshing the grain from the husks

Immunopathogenesis and therapeutic approaches in pediatric celiac disease

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