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.
Department of Medicine, Hotel Dieu de Quebec Hospital, Laval University, Canada.
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Paré
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Douville
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Caron
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Lagacé
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