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Celiac Disease: A Forty-Year Analysis in an Italian Referral Center
Lisa Lungaro1, Anna Costanzini1, Francesca Manza1
1Department of Translational Medicine, St. Anna Hospital, University of Ferrara, 44124 Ferrara, Italy.
Insights
Celiac disease (CD) diagnoses have increased, with non-classical and subclinical forms becoming more common over 40 years. This study analyzed clinical, serological, and histopathological CD findings in a large patient cohort.
Area of Science:
- Gastroenterology
- Immunology
- Internal Medicine
Background:
- Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion.
- This study analyzes a large, single-center cohort of CD patients over 40 years.
Purpose of the Study:
- To assess clinical, serological, and histopathological findings in a large celiac disease cohort.
- To evaluate changes in CD presentation over four decades.
Main Methods:
- Analysis of 1547 celiac disease patients diagnosed between 1980 and 2020.
- Recording of comorbidities, complications, and clinical, serological, and histopathological data.
Main Results:
- CD diagnoses quadrupled post-2000; non-classical CD (63.3%) and Marsh 3C (44.7%) were most prevalent.
- Common manifestations included osteopenia (59.9%), anemia (35.8%), and hypertransaminasemia (27.9%).
- Associated autoimmune disorders included thyroiditis (26.9%) and type 1 diabetes (2.9%).
Conclusions:
- Celiac disease presentation has evolved, with a rise in non-classical and subclinical phenotypes.
- Long-term cohort analysis provides insights into the changing landscape of celiac disease.
Background:
Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion. Herein, we assessed clinical, serological and histopathological findings of a single-center, large cohort of CD patients diagnosed and followed-up over forty years.
Methods:
From January 1980 to December 2020, 1547 CD patients (1170 females; age range: 8-81 years; F:M ratio = 3.1:1) were diagnosed in an Italian tertiary referral center. Comorbidities and complications were recorded at diagnosis and during follow-up.
Results:
CD diagnoses quadrupled after 2000. The most frequent phenotype was the non-classical CD (63.3%), and the most prevalent histotype was Marsh 3C (44.7%). Gastrointestinal manifestations, detectable in 51% of patients, were diarrhea (24.3%), bloating (28%) and aphthous stomatitis (19.7%). The most common CD-associated disorder was osteopenia (59.9%), predominant in females (64.3%); extraintestinal manifestations included anemia (35.8% iron-deficiency; 87% folic acid malabsorption), cryptogenic hypertransaminasemia (27.9%), and recurrent miscarriages (11.5%). Thyroiditis (26.9%), type 1 diabetes mellitus (2.9%), and dermatitis herpetiformis (1.4%) were the most common CD-related autoimmune disorders. Six patients had inflammatory bowel disease. Complications and mortality rate occurred in 1.8% and 1.9%, respectively.
Conclusions:
This single-center, large cohort analysis confirmed that CD presentation changed over the years, with an increase of non-classical and subclinical clinical phenotypes.
