title: Celiac disease: a disease with varied manifestations in adults and adolescents.
abstract: OBJECTIVE
  We aimed to determine the characteristics of patients with celiac disease and differences between those who presented during adolescence or adulthood.
  
  
  METHODS
  We retrospectively reviewed the case records of 233 consecutive patients with celiac disease who were diagnosed at 12-18 years or >18 years of age. The diagnosis of celiac disease was made on the basis of the modified European Society of Pediatric Gastroenterology, Hepatology and Nutrition criteria.
  
  
  RESULTS
  The diagnosis of celiac disease was made after 18 years of age in 153 (65.7%) patients. Median duration of symptoms at the diagnosis was 54 months (range 1 month to 29 years). In all, 103 (44.2%) patients with atypical manifestations were referred by other departments for evaluation. Chronic diarrhea (48.5%), short stature (27.0%) and chronic anemia (9.0%) were the common modes of presentation. Elevated level of aminotransaminase were present in 50 (24.3%) patients. Chronic diarrhea, hypocalcemia and hypoalbuminemia were present in significantly higher number of adult than adolescent patients. In all, 227 (97.4%) patients responded to a 6-month gluten-free diet and six non-responders were non-compliant.
  
  
  CONCLUSIONS
  More than 40% of the patients with celiac disease present to clinicians other than gastroenterologists or internists with atypical manifestations. A high index of suspicion is required for diagnosing its variant forms.
authors.affiliation: Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Minakshi
authors.initials: M
authors.lastname: Sharma
authors.forename: Prashant
authors.initials: P
authors.lastname: Singh
authors.forename: Abhishek
authors.initials: A
authors.lastname: Agnihotri
authors.forename: Prasenjit
authors.initials: P
authors.lastname: Das
authors.forename: Asha
authors.initials: A
authors.lastname: Mishra
authors.forename: Anil K
authors.initials: AK
authors.lastname: Verma
authors.forename: Arvind
authors.initials: A
authors.lastname: Ahuja
authors.forename: Vishnubhatla
authors.initials: V
authors.lastname: Sreenivas
authors.forename: Rajesh
authors.initials: R
authors.lastname: Khadgawat
authors.forename: Siddhartha Datta
authors.initials: SD
authors.lastname: Gupta
authors.forename: Govind K
authors.initials: GK
authors.lastname: Makharia
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000740:Anemia / Q000209:etiology; D001327:Autoimmune Diseases / Q000209:etiology; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000178:diet therapy / Q000276:immunology; D002908:Chronic Disease; D003967:Diarrhea / Q000209:etiology; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult
keywords: celiac disease; chronic diarrhea; malabsorption; short stature; small intestine; villous atrophy