[Adult celiac disease: importance of delay to diagnosis].
OBJECTIVE
Adult celiac disease is a genetically determined condition resulting from intolerance to gluten. This familial disease is associated with HLA B8 DR3 and is characterized by cytotoxic T-lymphocyte reaction in the digestive wall leading to a maladsorption syndrome. Adult celiac disease would be an expression of a silent disease already present in childhood.


METHODS
We conducted a retrospective study in 19 patients. Diagnosis was established in a department of internal medicine in adulthood. We analyzed histological findings and the clinical history and course.


RESULTS
The age curve at diagnosis peaked at 22 years and 67 years. Female sex predominated. Average delay to diagnosis was 3.1 years. The patients were admitted for reasons other than digestive disorders in 17 out of 19 cases. Careful history taking did however disclose subtle digestive signs. The principal manifestations were hematological disorders such as chronic anemia, abnormal liver function tests, and poor control of associated diseases. Type 1 diabetes mellitus was the main associated disease (4/19). Patients with prolonged nutritional deficiencies experienced serious situations.


CONCLUSIONS
Adult celiac disease is a clinical variant suggesting the presence of other non-digestive disorders. Specific antibodies should be assayed in patients with even minimal signs of deficiency in order to identify associated diseases. The principal cause of mortality is digestive T-cell lymphoma. A gluten-free diet is essential to control the course of this chronic disease.
Favre
G
G
Service de Médecine interne, Hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, F 67098 Strasbourg.
Grunenberger
F
F
Wurtz
E
E
Vinzio
S
S
Andres
E
E
Goichot
B
B
Schlienger
J L
JL
D000328:Adult; D017668:Age of Onset; D000368:Aged; D000906:Antibodies / Q000032:analysis; D002446:Celiac Disease / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D003922:Diabetes Mellitus, Type 1 / Q000209:etiology / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016399:Lymphoma, T-Cell / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D012189:Retrospective Studies
D000906:Antibodies