Vilppula A et al. (2008) Undetected coeliac disease in the elderly: a biopsy-proven population-based study. Dig Liver Dis 40: 809–813

Celiac disease is common, affecting up to 1% of the general population, but little is known about the prevalence of this disorder in the elderly. In the population-based study by Vilppula and colleagues, the prevalence of confirmed celiac disease in individuals aged 52 years or older was 2.13%. In addition, less than half of these cases were diagnosed on the basis of symptoms and the remaining patients were identified by antibody screening and biopsy, which indicates that celiac disease might be underdiagnosed in the elderly.

Vilppula et al. assessed 2,815 Finnish individuals aged 52–74 years, 25 (0.89%) of whom had previously been clinically diagnosed with celiac disease. Serum samples from all patients were screened for IgA tissue transglutaminase antibodies; participants who tested positive were offered upper gastrointestinal endoscopy, during which small intestine biopsy samples were taken.

Overall, 49 individuals tested positive for IgA tissue transglutaminase antibodies, 5 of whom had already been diagnosed with celiac disease. Of the remaining 44 patients, 35 were diagnosed with celiac disease on the basis of biopsy findings. The majority of patients previously diagnosed with celiac disease had classic symptoms (i.e. diarrhea, weight loss), whereas all but one of the patients diagnosed by screening and biopsy had subtle symptoms (i.e. abdominal pain, loose stools) or no symptoms at all.

The authors recommend that clinicians should be alert to celiac disease in the elderly and should implement active case finding by serologic screening.