Classic Presentation of Celiac Disease Is Not Most Common
This interesting portion of this article is that one third of patients in this study were originally identified as having irritable bowel syndrome. Most patients had seen three physicians before the correct diagnosis was made. Celiac disease is an allergy to one of the proteins found in certain grains, principally wheat. The take home message here is that any patient with IBS (and any GI complaints in general) needs to be put on an elimination diet devoid of the common allergens wheat, dairy, corn and soy.
66th Annual Scientific Meeting of the American College of Gastroenterology The classic presentation of celiac disease, severe malabsorption symptoms beginning in childhood, is actually not the most common presentation, according to study findings presented Monday at the 66th Annual Scientific Meeting of the American College of Gastroenterology. Dr. Robert D. Zipser, from Harbor-UCLA Medical Center in Torrance, California, and colleagues surveyed 1032 patients with biopsy-proven celiac disease to determine the most common presentations. The median age at diagnosis was 46 years and 14 patients were over 80 years when first diagnosed, the investigators note. Only 12% of patients were diagnosed before 10 years of age. Most patients had normal weights at diagnosis. While diarrhea was a common initial symptom, a few patients presented with constipation. Anemia, fatigue, flatus, bloating, and abdominal pain were also frequent presentations. Five percent of patients were asymptomatic. Most patients saw three physicians prior to being diagnosed. More than a third of patients were initially diagnosed with irritable bowel syndrome, the investigators report. The median time from initial presentation to biopsy-proven diagnosis was 1 year. However, 19% of patients had symptoms for more than 10 years before being diagnosed. “The goal of the study was to help physicians recognize celiac disease,” says Dr. Zipser. “Physicians often think of it as a rare malabsorptive disease limited to childhood,” he said. “However, the current findings indicate that celiac disease usually presents in adulthood with symptoms mimicking those of irritable bowel syndrome,” he added. While the findings indicate that adult onset is common, Dr. Zipser pointed out that for a small minority of patients the disease was probably missed during childhood. “Many symptoms which are typical of the childhood form are relatively uncommon in the adult form,” Dr. Zipser stated. For example, “weight loss is common in the childhood form, but uncommon in the adult form,” he noted. In fact, he added “some of the patients were actually obese,” he added. While all of the patients in the current study underwent small bowel biopsy, Dr. Zipser noted that it is now quite easy to diagnose celiac disease. “A simple blood test can determine whether antibodies to wheat products are being made,” he explained.