title: Changing presentation of adult celiac disease.
abstract: The mode of presentation of celiac disease in the United States is not known. We investigated the demographic and clinical features of 227 patients with biopsy-proven celiac disease and determined if there had been changes over time. The patients had been entered into a database; those seen prior to 1990 were retrospectively entered while those seen subsequently were prospectively entered. A "symptomatic" presentation described the "classical" presentation of celiac disease with prominent gastrointestinal symptoms: diarrhea and weight loss. Females were younger and had a longer duration of symptoms compared to males. The modes of presentation were symptomatic (62%), anemia or reduced bone density (15%), screening first-degree relatives (13%), and incidental diagnosis at endoscopy (8%). We compared those diagnosed before and after 1993 (when serologic testing was first used), and noted a reduction in those presenting with diarrhea, 73% vs 43% (P = 0.0001) and a reduction in the duration of symptoms, from 9.0 +/- 1.1 years to 4.4 +/- 0.6 years (P < 0001). In conclusion, the percentage of celiac disease patients presenting with diarrhea has decreased, probably related to the more widespread use of serologic testing for celiac disease.
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Winson
authors.initials: W
authors.lastname: Lo
authors.forename: Kevin
authors.initials: K
authors.lastname: Sano
authors.forename: Ben
authors.initials: B
authors.lastname: Lebwohl
authors.forename: Beverly
authors.initials: B
authors.lastname: Diamond
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D003967:Diarrhea; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors; D015431:Weight Loss