Abstract
BackgroundCeliac disease is a multiform, challenging condition characterized by extremely variable features. Our goal was to define clinical, serological and histopathological findings in a large cohort of celiacs diagnosed in a single referral center.MethodsFrom January 1998 to December 2012, 770 patients (599 females, median age 36 years, range 18-78 years) were diagnosed as celiacs at St.Orsola-Malpighi Hospital (Bologna, Italy). The clinical phenotypes were classified as: 1) classical (malabsorption syndrome); 2) non-classical (extraintestinal and/or gastrointestinal symptoms other than diarrhea); 3) subclinical. Serology, duodenal histology, comorbidities, response to gluten-free diet and complications were evaluated.ResultsDisease onset was symptomatic in 610 patients (79%), while 160 celiacs showed a subclinical phenotype. In the symptomatic group the non-classical prevailed over the classical phenotype (66% vs 34%). Diarrhea was found in 27%, while other gastrointestinal manifestations were bloating (20%), aphthous stomatitis (18%), alternating bowel habit (15%), constipation (13%) and gastroesophageal reflux disease (12%). Extraintestinal manifestations included osteopenia/osteoporosis (52%), anemia (34%), cryptogenic hypertransaminasemia (29%) and recurrent miscarriages (12%). Positivity for IgA tissue transglutaminase antibodies was detected in 97%. Villous atrophy was found in 87%, while 13% had minor lesions consistent with potential celiac disease. A large proportion of patients showed autoimmune disorders, i.e. autoimmune thyroiditis (26.3%), dermatitis herpetiformis (4%) and diabetes mellitus type 1 (3%). Complicated celiac disease was very rare.ConclusionsOur study demonstrates that the clinical profile of celiac disease changed over time with an increasing rate of non-classical and subclinical phenotypes.
Highlights
Celiac disease is a multiform, challenging condition characterized by extremely variable features
There are no comparative studies on the prevalence of symptoms/manifestations in functional bowel disorders and celiac disease (CD) patients, we demonstrated such symptoms in about 20% of cases suggesting a link between gastrointestinal functional impairment and CD
In our study we evaluated the response to gluten free diet (GFD) in 654 CD patients, followed-up for a period ranging from 18 months to 14 years
Summary
Celiac disease is a multiform, challenging condition characterized by extremely variable features. Our goal was to define clinical, serological and histopathological findings in a large cohort of celiacs diagnosed in a single referral center. Until the end of the second millennium, the classic view of celiac disease (CD) was that of a rare food intolerance characterized by villous atrophy and overt malabsorption mainly affecting pediatric patients. The identification of biomarkers, e.g. antibodies to endomysium (EmA) [9] and to TG2 (anti-TG2) [10], has changed the epidemiology of CD from a rare to a frequent condition with an expected prevalence higher than 1% in the worldwide population. Serological screening has allowed an early CD diagnosis in its preclinical stage with the result that symptom presentation has radically changed compared to the past [12,13]. The different mode of presentation has led experts to elaborate the Oslo classification which subdivides CD in symptomatic, i.e. “classical” and “non-classical”, vs. clinically silent, i.e. “subclinical”, phenotypes [15]
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