Trends in the presentation of celiac disease.
OBJECTIVE
Screening studies have revealed that celiac disease is common in the United States; however, there are scant data on the mode of presentation. We analyzed the trends in clinical presentation over the last 52 years in a large cohort of biopsy-proven patients seen in 1 center.


METHODS
Patients (n = 590) were divided into 6 groups based on the year of diagnosis (1952-2004). Groups were compared for trends in age at diagnosis, childhood diagnosis, duration of symptoms, mode of presentation (diarrhea, bone disease, anemia, incidental at esophagogastroduodenoscopy, screening), and presence of malignancy.


RESULTS
Diagnosis was at an older age since 1980 (P = .007), and there was a significant negative linear trend in patients presenting with diarrhea (P<.001) over time and a positive linear trend in asymptomatic patients detected on screening (P<.001). There was a significant negative linear trend in patients with a malignancy (P = .02) and duration of symptoms before diagnosis of celiac disease (P = .001), although only the subgroup without diarrhea had improvement in delay of diagnosis of celiac disease (assessed by a shorter duration of symptoms) (P = .05). Comparison of patients with and without diarrhea showed no significant difference in age (42.9 years vs 43.7 years, P = .59), gender (29.3% M vs 34.6%, P = .59), and presence of childhood disease (8.0% vs 9.8%, P = .43) or malignancies (9.8% vs 8.9%, P = .71).


CONCLUSIONS
There is a trend toward fewer patients presenting with symptomatic celiac disease characterized by diarrhea and a significant shift toward more patients presenting as asymptomatic adults detected at screening.
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
S Devi
SD
Rampertab
Nakechand
N
Pooran
Pardeep
P
Brar
Pankaj
P
Singh
Peter H R
PH
Green
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000747:Anemia, Hypochromic / Q000209:etiology; D001851:Bone Diseases, Metabolic / Q000209:etiology; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003967:Diarrhea / Q000209:etiology; D016145:Endoscopy, Digestive System; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications; D006801:Humans; D033162:Incidental Findings; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017678:Sex Distribution; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL