Celiac disease is an immune-mediated enteropathy characterized with high heterogeneity in presentation among genetically predisposed individuals.
In recent years, a change in the phenotypic presentation of celiac disease has been reported.
Dr Patricia Dominguez Castro and colleagues from Ireland studied clinical presentation, from 1960 through 2015, in Ireland, which has a high incidence of celiac disease.
The researchers performed a retrospective analysis of medical charts from patients diagnosed with celiac disease at 5 secondary referral centers in Ireland from 1960 through 2015.
|The proportion of patients with nonclassical or subclinical celiac disease increased from 15% to 52%|
|Clinical Gastroenterology & Hepatology|
The cohort was divided into 5 groups based on year of diagnosis.
The team collected findings from clinical presentation at diagnosis; serology tests; small intestinal biopsy analyses; and patients’ demographic, clinical, and family data.
Presentations at diagnosis were classified according to the Oslo criteria as follows: classical, nonclassical, or subclinical.
The team's primary outcome was change in clinical presentation of celiac disease over time.
Of the 749 patients studied, the researchers report that 512 were female and 237 were male.
Female patients were diagnosed at younger ages than male patients, and had more immune-mediated conditions than male patients.
For patients diagnosed as adults, the median age of diagnosis increased from 34 years during the period ≤1985 to median ages of 44–46 years after 1985.
A smaller proportion of patients presented with classical features of celiac disease after 2010 than ≤1985.
The researchers found that the proportion of patients with nonclassical or subclinical celiac disease increased from 15% ≤1985 to 52% after 2010.
Biopsies categorized as Marsh 3c decreased, from 52% in the period 1996–2005 to 23% in the period after 2010.
The prevalence of associated thyroid disease has decreased during the study period, from 37% ≤1985 to 17% after 2010, whereas body mass index at diagnosis increased from 21.5 kg/m2 ≤1985 to 24.8 kg/m2 after 2010.
Dr Castro's team concludes, "We found the clinical presentation of celiac disease changed significantly in Ireland from 1960 through 2015."
"The age of presentation in adulthood increased over this time period, as did the proportions of patients with nonclassical or subclinical disease."