Celiac disease in elderly adults: clinical, serological, and histological characteristics and the effect of a gluten-free diet.
OBJECTIVE
To compare celiac disease (CD) in older and younger adults and to assess the effects of a gluten-free diet (GFD).


METHODS
Retrospective retrieval of information prospectively entered into a structured database.


METHODS
CD clinic, University and Spedali Civili, Brescia, Italy.


METHODS
Two cohorts were identified (older, Group A, n = 59, >65; younger, Group B, n = 1,166, 18-64), and Group B was subgrouped (B1, n = 600, 18-34; B2, n = 440, 35-49; and B3, n = 26, 50-64).


METHODS
Clinical, serological, and histological characteristics of individuals with CD studied before and during a GFD.


RESULTS
At presentation, weight loss (37% vs 21%, P = .005) and dyspepsia (22% vs 12%, P = .04) were more frequent in older than younger participants. Incidence at diagnosis of non-Hodgkin's lymphoma (NHL) was much higher in older (5%) than younger participants (0.3%, P = .003). Prevalence of osteoporosis was 67% in older and 14% in younger male participants and 70% in older and 9% in younger female participants ( P < .001). During treatment, adherence to a GFD was 90%, normal villous structure was reconstituted, and t-transglutaminase antibodies were negative in 80% of older and younger participants. Lumbar-sacral and femoral T scores increased significantly during a GFD in pooled results of 48 older and younger participants studied before and during GFD.


CONCLUSIONS
NHL is already present at CD diagnosis in most cases in individuals aged 50 and older, emphasizing the importance of early diagnosis. Older and younger individuals are equally adherent and equally benefit from a GFD, indicating that older age is not a barrier to dietary treatment.
Gastroenterology Unit, University and Spedali Civili Hospital, Brescia, Italy.
Silvia
S
Casella
Barbara
B
Zanini
Francesco
F
Lanzarotto
Vincenzo
V
Villanacci
Chiara
C
Ricci
Alberto
A
Lanzini
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D002446:Celiac Disease / Q000097:blood / Q000150:complications* / Q000178:diet therapy* / Q000453:epidemiology; D016009:Chi-Square Distribution; D055050:Diet, Gluten-Free; D004415:Dyspepsia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D015995:Prevalence; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D015431:Weight Loss
D015415:Biomarkers