title: Symptoms and findings in adult-onset celiac disease in a historical Danish patient cohort.
abstract: OBJECTIVE
  The presentation of celiac disease (CD) has changed over the past decades. We aimed to describe the incidence of CD and its complications at diagnosis in a historical cohort in a well-defined population in Denmark.
  
  
  METHODS
  We included all patients aged 15+ years, who lived in Aarhus County, Denmark, and who were diagnosed with CD between January 2008 and August 2013. Data regarding gastrointestinal symptoms, anthropometrics, biochemistry, and bone mineral density were retrieved from patient records.
  
  
  RESULTS
  A total of 93 patients with a valid CD diagnosis were identified, corresponding to an incidence rate of 6.4 per 100,000 person-years. At diagnosis, diarrhea and weight loss occurred in 54% and 47% patients, respectively. In total, 30% had anemia; 40%, iron deficiency; 20%, folate deficiency; and 17%, vitamin B12 deficiency. Vitamin D deficiency was present in 34%. In 28%, bone mineral density was determined during the first year after diagnosis. Of these, 54% had osteopenia and 12% osteoporosis. After introduction of a gluten-free diet, 28% had normalized transglutaminase antibody levels after 6 months, and 56% did after 12 months. Diabetes mellitus type 1 was present in 7%; dermatitis herpetiformis, in 3%; and thyroid dysfunction, in 5%.
  
  
  CONCLUSIONS
  Only half of newly diagnosed CD patients presented with classic gastrointestinal symptoms. Anemia and vitamin deficiencies were common. Bone mineral density was determined in less than a third of the patients, and osteoporosis occurred in 12% of these. Serologic markers of CD normalized in approximately half of patients during the first year after the diagnosis.
authors.affiliation: a Department of Hepatology and Gastroenterology , Aarhus University Hospital , Aarhus C , Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Schøsler
authors.affiliation: a Department of Hepatology and Gastroenterology , Aarhus University Hospital , Aarhus C , Denmark.
authors.forename: Lisbet A
authors.initials: LA
authors.lastname: Christensen
authors.affiliation: a Department of Hepatology and Gastroenterology , Aarhus University Hospital , Aarhus C , Denmark.
authors.forename: Christian L
authors.initials: CL
authors.lastname: Hvas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology; D001323:Autoantibodies / Q000097:blood; D015519:Bone Density; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D003874:Dermatitis Herpetiformis / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology; D003967:Diarrhea / Q000209:etiology; D005260:Female; D005492:Folic Acid; D005494:Folic Acid Deficiency / Q000209:etiology; D019204:GTP-Binding Proteins / Q000276:immunology; D006801:Humans; D015994:Incidence; D000090463:Iron Deficiencies; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012189:Retrospective Studies; D063189:Symptom Assessment; D013959:Thyroid Diseases / Q000453:epidemiology; D011503:Transglutaminases / Q000276:immunology; D014806:Vitamin B 12 Deficiency / Q000209:etiology; D014808:Vitamin D Deficiency / Q000209:etiology; D015431:Weight Loss
chemical_list: D001323:Autoantibodies; D005492:Folic Acid; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
keywords: Celiac disease; epidemiology; osteoporosis