Adult celiac sprue: changes in the pattern of clinical recognition.
We report the clinical, laboratory, and pathological findings in a series of 52 consecutive patients with adult celiac sprue observed over a 20-year period. The frequency of that diagnosis increased from an average of 0.7 case/year during the period 1966-1975 to 5.8 cases/year during the period 1981-1985. Apart from two patients with dermatitis herpetiformis, nonclassical clinical presentations were observed in 16 of 50 (32%) patients overall and in 13 of 28 (46%) patients diagnosed since 1981. Diarrhea was the most common complaint leading to the diagnosis; since 1981, hematologic abnormalities warranted investigation in 38% of the patients. Decreased iron stores (88%), decreased red cell folate (82%), or both (74%), and abnormal radiographic studies of the small bowel (83%) were the most sensitive tests in the diagnostic investigation. We conclude that atypical or nonclassical presentations of adult celiac sprue, mostly with hematologic abnormalities, are not uncommon.
Paré
P
P
Department of Medicine, Hotel Dieu de Quebec Hospital, Laval University, Canada.
Douville
P
P
Caron
D
D
Lagacé
R
R
D000005:Abdomen; D000328:Adult; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000209:etiology; D002446:Celiac Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D003967:Diarrhea / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology