Author:
Vilppula Anitta,Kaukinen Katri,Luostarinen Liisa,Krekelä Ilkka,Patrikainen Heikki,Valve Raisa,Luostarinen Markku,Laurila Kaija,Mäki Markku,Collin Pekka
Abstract
Abstract
Background
The utility of serologic screening for celiac disease is still debatable. Evidence suggests that the disorder remains undetected even in the older population. It remains obscure whether screening makes good or harm in subjects with long-standing gluten ingestion. We evaluated whether older subjects benefit from active detection and subsequent gluten free dietary treatment of celiac disease.
Methods
Thirty-five biopsy-proven patients aged over 50 years had been detected by serologic mass screening. We examined the disease history, dietary compliance, symptoms, quality of life and bone mineral density at baseline and 1-2 years after the commencement of a gluten-free diet. Symptoms were evaluated by gastrointestinal symptom rating scale and quality of life by psychological general well-being questionnaires. Small bowel biopsy, serology, laboratory parameters assessing malabsorption, and bone mineral density were investigated.
Results
Dietary compliance was good. The patients had initially low mean serum ferritin values indicating subclinical iron deficiency, which was restored by a gluten-free diet. Vitamin B12, vitamin D and erythrocyte folic acid levels increased significantly on diet. Celiac patients had a history of low-energy fractures more often than the background population, and the diet had a beneficial effect on bone mineral density. Alleviation in gastrointestinal symptoms was observed, even though the patients reported no or only subtle symptoms at diagnosis. Quality of life remained unchanged. Of all the cases, two thirds would have been diagnosed even without screening if the family history, fractures or concomitant autoimmune diseases had been taken carefully into account.
Conclusions
Screen-detected patients benefited from a gluten-free diet. We encourage a high index of suspicion and active case-finding in celiac disease as an alternative to mass screening in older patients.
Publisher
Springer Science and Business Media LLC
Subject
Gastroenterology,General Medicine
Reference20 articles.
1. Murray JA, Van Dyke C, Plevak MF, Dierkhising RA, Zinsmeister AR, Melton LJ: Trends in the identification and clinical features of celiac disease in a North American community, 1950-2001. Clin Gastroenterol Hepatol. 2003, 1: 19-27. 10.1053/jcgh.2003.50004.
2. Vilppula A, Kaukinen K, Luostarinen L, Krekelä I, Patrikainen H, Valve R, Mäki M, Collin P: Increasing prevalence and high incidence of celiac disease in elderly people: A population-based study. BMC Gastroenterology. 2009, doi:10.1186/1471-230X-9-49
3. Hankey GL, Holmes GKT: Coeliac disease in the elderly. Gut. 1994, 35: 65-67. 10.1136/gut.35.1.65.
4. Lurie Y, Landau DA, Pfeffer J, Oren R: Celiac disease diagnosed in the elderly. J Clin Gastroenterol. 2008, 42: 59-61. 10.1097/01.mcg.0000247995.12087.7b.
5. Mustalahti K, Collin P, Sievänen H, Salmi J, Mäki M: Osteopenia in patients with clinically silent coeliac disease warrants screening. Lancet. 1999, 354: 744-745. 10.1016/S0140-6736(99)01990-X.
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