Hydrogen breath test with D-xylose for celiac disease screening is as useful in the elderly as in other age groups

Up to one fifth of celiac disease patients are diagnosed after the age of 60. The hydrogen breath test with D-xylose as substrate (xylose-BT) has proved useful for the diagnosis of adult celiac disease. Our aim was to determine the potential influence of age-related intestinal mucosal changes on the reliability of this test. We reviewed the results of the xylose-BT in 50 patients with clinical celiac disease in whom the diagnosis was confirmed by histology. A control group of 53 patients with various diarrheal disorders and without jejunal mucosal atrophy at biopsy was similarly studied. Both celiac patients and controls were divided into adults (age < or = 60 years) and elderly (age >60 years). Seven of the 50 celiacs and 8 of the 53 controls were in the elderly category (P = NS). In the celiac disease group, no differences were observed between the elderly and adult patient subgroups for basal H2 excretion (22.4 +/- 42 vs 9.7 +/- 11 ppm), delta increase (56 +/- 43 vs 53 +/- 36 ppm), or area under the curve (7,452 +/- 5,546 vs 6,739 +/- 5,951 ppm x min). The false negative rate was similar for celiac adult (7/43) and elderly (2/7, P = ns) patients. Sensitivity of the xylose-BT was 0.83 in adults and 0.71 in the elderly, and specificity 0.51 in adults and 0.50 in the elderly. In conclusion, the results of the xylose-BT in celiac patients are not influenced by age. The xylose-BT is as valuable a tool for the screening of celiac disease in the elderly as it is in younger patients.