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Celiac disease in the elderly

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 697–706 (2008)Cite this article

Abstract

Celiac disease is a common condition that is thought to affect 1 in 200 people throughout Europe and America, with prevalence rates reaching 1:100 in Ireland. Improvements in the sensitivity and specificity of serological testing for celiac disease over the past 15 years have resulted in a larger number of diagnoses being made. Up to 34% of patients with newly diagnosed celiac disease are older than 60 years of age. The symptomatic presentation of celiac disease in elderly patients can be subtle, leading to a considerable delay in diagnosis and potential accumulation of associated secondary complications. Given that celiac disease is associated with significant morbidity and reduced life expectancy, physicians need to be aware of this condition and its occurrence in the current increasingly elderly population. Compliance with a strict gluten-free diet is as easily achieved in elderly patients as in younger patients, and has been reported to reduce the risks of cancer and lymphoma associated with celiac disease. This Review highlights age-related differences in the clinical presentation and investigation of patients with suspected celiac disease.

Key Points

  • As the prevalence of celiac disease increases, a greater proportion of new diagnoses are being made in individuals over 60 years of age

  • There is often a delay in the diagnosis of celiac disease in elderly individuals, which occurs partly due to a lack of clinical awareness and has been shown to reduce lifespan

  • Age should not be a contraindication to the lifestyle changes necessary when adopting a gluten-free diet, as compliance rates are similar for elderly patients and their younger counterparts, if not better

  • A strict gluten-free diet can improve many of the secondary biochemical and autoimmune disorders associated with celiac disease, and has been shown to reduce the associated tumor risk

  • There are many age-related differences in the clinical presentation and investigation of patients with suspected celiac disease. A greater awareness among clinicians of this condition in the elderly will help improve the quality of life for many elderly patients while reducing the associated morbidity and mortality

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Figure 1: Algorithm for the diagnosis and treatment of celiac disease in elderly patients.

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Authors and Affiliations

  1. and PJ Ciclitira is Head of Department of Gastroenterology Research at St Thomas' Hospital, MW Johnson is a Gastroenterology Consultant at the Royal Surrey Hospital, London, HJ Ellis is a Senior Research Fellow at King's College London, London, MA Asante is a Gastroenterology Consultant at the Bromley Hospitals NHS Trust, Kent, London, UK.,

    Matthew W Johnson, H Julia Ellis, Max A Asante & Paul J Ciclitira

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  1. Matthew W Johnson
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  2. H Julia Ellis
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Correspondence to Paul J Ciclitira.

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Johnson, M., Ellis, H., Asante, M. et al. Celiac disease in the elderly. Nat Rev Gastroenterol Hepatol 5, 697–706 (2008). https://doi.org/10.1038/ncpgasthep1281

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