Posted by: Chris Maloney | August 27, 2011

Gut Trouble: 1 in 133 Have Celiac, and 2/3rds Don’t Know It.

Biopsy of small bowel showing coeliac disease ...

Image via Wikipedia

Some very troubling news about celiac, which is five times higher now than it was in the 1950’s.  And no, we’re not just diagnosing it more according to the article.  The rate of celiac has doubled every fifteen years since 1974 according to an article in USA Today.

As to why, we have the too-clean hypothesis, the not-breast-feeding hypothesis, and the too-much-gluten hypothesis.  Evidently the our-moral-fiber-is-decaying hypothesis didn’t make the cut.

But when you start looking at the data on celiac, what shows up more and more is the awareness of celiac.  Below is a perfect example, citing the fact that a minority of patients with celiac present with classical signs.  Most present only with anemia, which previously would have been likely to be treated with an iron pill.

So, is it really a change in the population, or a change in medical awareness of the disease?  What is really unfortunate is that bread is so bad for so many people.  Bring on the gluten-free bakers?  But also it’s time to start screening our children for an allergy like this before we put them on lifelong medication for “acting out.”

Nutr J. 2006 Sep 14;5:24.

Patterns of clinical presentation of adult coeliac disease in a rural setting.


Dietetics, Royal Gwent Hospital. Newport, Gwent, South Wales, UK.



In recent years there has been increasing recognition that the pattern of presentation of coeliac disease may be changing. The classic sprue syndrome with diarrhoea and weight loss may be less common than the more subtle presentations of coeliac disease such as an isolated iron deficiency anaemia. As a result, the diagnosis of this treatable condition is often delayed or missed. Recent serologic screening tests allow non-invasive screening to identify most patients with the disease and can be applied in patients with even subtle symptoms indicative of coeliac disease. Both benign and malignant complications of coeliac disease can be avoided by early diagnosis and a strict compliance with a gluten free diet.


The aim of this study is to evaluate the trends in clinical presentation of patients diagnosed with adult coeliac disease. In addition, we studied the biochemical and serological features and the prevalence of associated conditions in patients with adult coeliac disease.


This is an observational, retrospective, cross-sectional review of the medical notes of 32 adult patients attending the specialist coeliac clinic in a district general hospital.


Anaemia was the most common mode of presentation accounting for 66% of patients. Less than half of the patients had any of the classical symptoms of coeliac disease and 25% had none of the classical symptoms at presentation. Anti-gliadin antibodies, anti-endomysial antibody and anti-tissue transglutaminase showed 75%, 68% and 90% sensitivity respectively. In combination, serology results were 100% sensitive as screening tests for adult coeliac disease. Fifty nine percent patients had either osteoporosis or osteopenia. There were no malignant complications observed during the follow up of our patients.


Most adults with coeliac disease have a sub clinical form of the disease and iron deficiency anaemia may be its sole presenting symptom. Only a minority of adult coeliac disease patients present with classical mal-absorption symptoms of diarrhoea and weight loss. Patients with atypical form of disease often present initially to hospital specialists other than a gastro-enterologist. An awareness of the broad spectrum of presentations of adult coeliac disease, among doctors both in primary care and by the various hospital specialists in secondary care, is necessary to avoid delays in diagnosis. It is important to include serological screening tests for coeliac disease systematically in the evaluation of adult patients with unexplained iron deficiency anaemia or unexplained gastro-intestinal symptoms and in those who are considered to be at increased risk for coeliac disease.


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