Celiac disease in adults

Area of Science:

• Gastroenterology and Immunology
• Endocrinology and Metabolism

Background:

• Celiac disease is a prevalent autoimmune disorder affecting genetically susceptible individuals upon gluten ingestion.
• It affects approximately 1% of the population, with a higher incidence in women, and is a significant cause of malabsorption.
• Manifestations range from asymptomatic cases to severe malabsorption syndrome, with extraintestinal symptoms common in adults.

Observation:

• This case report details a 58-year-old patient diagnosed with celiac disease at an advanced age.
• The diagnosis was prompted by non-classical symptoms, specifically multiple pathological fractures.
• These fractures stemmed from metabolic bone disease secondary to malabsorption of calcium and vitamin D, leading to hyperparathyroidism.

Findings:

• The gold standard for celiac disease diagnosis involves detecting tissue transglutaminase IgA antibodies and confirming histological findings from a duodenal biopsy.
• This patient's late diagnosis underscores the varied clinical presentations of celiac disease.
• Non-classical symptoms, such as metabolic bone disease and secondary hyperparathyroidism, can be key indicators.

Implications:

• A lifelong gluten-free diet is the established causal treatment for celiac disease.
• Strict adherence to a gluten-free diet is crucial for mitigating serious complications like intestinal T-cell lymphoma.
• This case emphasizes the importance of considering celiac disease in adults presenting with unexplained metabolic bone disease and malabsorption, even in the absence of typical gastrointestinal symptoms.