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Trends in clinical presentation of celiac disease in the us over the last fifty years

Trends in clinical presentation of celiac disease in the us over the last fifty years

Digestive Disease Week Abstracts & Itinerary Planner : Abstract No W1379

Background: There is little data regarding the presentation of celiac disease (CD) in the US. We therefore analyzed the trends in clinical presentation in a large cohort of CD patients over the last 50 years. Methods: A database consisting of 441 (148M, 293F) biopsy-proven patients diagnosed between 1952 and 2002 was reviewed. Patients were divided into 6 groups based on year of diagnosis. The 6 groups were compared for trends in age, childhood diagnosis, mode of presentation (i.e. diarrhea, bone disease, anemia, those discovered incidentally during endoscopy, those discovered by screening relatives of patients with CD) and presence of malignancy. Results: There was a negative linear trend (p=0.001) in patients presenting with diarrhea over time. Conversely, there was a positive linear trend (p=0.001) in detection by screening relatives of CD patients. There was no statistical significance in patients presenting with bone disease, anemia or incidentally at endoscopy. In addition, patients were diagnosed at an older age since 1980 (p=0.02) and there was a significant negative linear trend in the percentage of patients with a childhood diagnosis (p=0.005). There was a positive trend, though not statistically significant (p=0.054), in the prevalence of malignancy in patients with CD over time. When comparing those with diarrhea vs those without diarrhea, there was no statistical difference in age (44.0 vs 44.6 yr, p=0.7), sex (32% M vs 35% M, p=0.4), presence of childhood disease (8% vs 9%, p=0.8), presence of autoimmune disease (20% vs 20%, p=0.9) and the prevalence of malignancies (10% vs 12%, p=0.5). Conclusion: CD is increasingly detected by screening relatives of patients with the disease. Since fewer patients are presenting with diarrhea, this suggests that the bulk of patients with CD are asymptomatic. Whether earlier detection of asymptomatic patients has an impact on morbidity of CD remains to be elucidated.

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Accession: 035985274

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DOI: 10.1016/S0016-5085(03)83338-3

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