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Coeliac Disease in the 21st Century: No Longer "Kids' Stuff"
Alfredo J Lucendo1, Álvaro García-Manzanares2, Ángel Arias3
1Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain.
Insights
Coeliac disease (CD) is now predominantly diagnosed in adults, not children. Adult CD often presents with non-classic symptoms and requires new diagnostic approaches.
Area of Science:
- Gastroenterology
- Immunology
- Internal Medicine
Background:
- Coeliac disease (CD) was historically viewed as a paediatric condition.
- Recent years have seen an increased incidence of adult-onset CD.
- This study investigates the current prevalence and presentation of CD in adults versus children.
Purpose of the Study:
- To determine if CD remains primarily a paediatric disorder.
- To compare the clinical presentation and diagnostic findings of adult-onset CD versus paediatric CD.
- To highlight the need for updated diagnostic strategies for adult CD.
Main Methods:
- Observational, descriptive, and retrospective study design.
- Data collected from paediatric and adult patients newly diagnosed with CD in 2010 across two Spanish hospitals.
- Diagnosis confirmed by clinical history, serology, HLA-DQ, duodenal biopsies, and gluten-dependent symptoms.
Main Results:
- Out of 79 CD diagnoses in 2010, 86.1% were adults.
- Classic CD symptoms (diarrhoea, anaemia) were more common in children (90.9%) than adults (54.4%).
- Adults commonly presented with abdominal pain, dyspepsia, and GERD-like symptoms; Marsh III atrophy and positive tTGA were less frequent in adults compared to children.
Conclusions:
- Adult-onset CD was the predominant form in the studied population in 2010.
- Coeliac disease can no longer be considered a predominantly paediatric disorder.
- Adult CD often features Marsh I histology and negative tTGA, necessitating revised diagnostic algorithms.
Background:
We aimed to determine if Coeliac disease (CD) can be still be considered a predominantly paediatric disorder, in spite of the increased incidence of adult-onset CD reported in recent years.
Methods:
An observational, descriptive, and retrospective study was developed at two Spanish hospitals. Data was collected and analyzed from all paediatric and adult patients newly diagnosed with CD throughout the year 2010. CD diagnoses were based on a concordant clinical history, serology, HLA-DQ compatibility, the presence of mucosal lesions in duodenal biopsies with gluten dependence of symptoms, and histological lesions.
Results:
A total of 79 patients were diagnosed with CD throughout 2010, of which 68 (86.1%) were adults. Classic symptoms (diarrhoea and iron-deficiency anaemia) were more frequent in children (90.9%), being present in only 54.4% of adults (p = 0.02). Adult patients showed, mainly, abdominal pain, dyspepsia, and GERD-related symptoms. Villous atrophy (Marsh III) was present in 63.7% of children, but only in 19.1% of adults (p = 0.004). Positive tTGA was present in 81.8% of the children and only in 19.1% of the adults (p = 0.004). Haemoglobin levels were significantly lower in children (p = 0.025), but no differences were observed in iron and ferritin blood levels.
Conclusions:
Our study shows that adult-onset CD was the predominant presentation in two hospitals in Spain in the year 2010. Therefore, CD can no longer be considered a predominantly paediatric disorder. Marsh I and negative tTGA titters are characteristic in most of adults. New diagnostic algorithms are needed to improve correct diagnosis of CD in adults.
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