Celiac disease is a condition that causes damage to the small intestine. This area of the digestive tract is lined with tiny, finger-like projections, called villi, which absorb nutrients from food. People with Celiac disease react to gluten, a protein found in wheat, rye, barley and some food/medicinal products. When gluten is ingested, the immune system responds by attacking the villi. The damaged villi can’t absorb nutrients. Over time, patients can develop nutritional deficiencies, weight loss, anemia, brittle bones (osteoporosis) and an itchy skin rash (dermatitis herpetiformis).
According to the National Institute of Diabetes and Digestive and Kidney Disease, about 2 million people in the U.S. (one in 133) have Celiac disease. The condition is often diagnosed during childhood. Signs in young patients can include: growth problems, vomiting, bloating, chronic diarrhea or constipation, weakness/fatigue, migraines and behavior problems.
There is no cure for Celiac disease. The only treatment is a gluten-free diet. Patients must avoid all sources of gluten, because even a tiny amount can damage the intestinal villi. It’s not an easy task, because gluten is often hidden in binders and fillers in foods and drugs. However, Alessio Fasano, M.D., Pediatric Gastroenterologist with the University of Maryland School of Medicine in Baltimore, says, if patients are successful in avoiding gluten, the symptoms will go away and the intestinal lining will heal.
Celiac Diagnosis in Adulthood
Though Celiac disease is often considered a childhood illness, onset can occur at any age. Researchers have reported that the condition is being more commonly first diagnosed in adulthood. One study found the median age for newly diagnosed adult patients was just under 50. Another study reports 25 percent of new adult cases are diagnosed after 70.
Diagnosis in adults is tricky. Older patients are much less likely to have the digestive symptoms associated with Celiac in children. Instead, adults are more likely to have anemia, fatigue, bone pain, arthritis, neuropathy, or menstrual disorders. These symptoms can be indicative of a number of conditions commonly seen in adults. And, since Celiac disease is not commonly diagnosed in adulthood, a physician may not immediately consider it as a possible diagnosis. Fasano says even when an adult Celiac patient is placed on a gluten-free diet, it can take longer than expected for the symptoms to go away.
Physicians need to be aware that adult patients often don’t meet the clear-cut diagnostic criteria for Celiac diagnosis. The key to diagnosis is often the frequency and severity of symptoms. As with children, the only treatment is a gluten-free diet.
American College of Gastroenterology, http://www.acg.gi.org
Celiac Disease Foundation, http://www.celiac.org
National Foundation for Celiac Awareness, http://www.celiaccentral.org
National Institute of Diabetes and Digestive and Kidney Diseases, http://www.niddk.nih.gov
Jones, Sian, et al., “Patterns of Clinical Presentation of Adult Coeliac Disease in a Rural Setting,” Nutrition Journal, September 14, 2006, Vol. 5, p. 24.
Rashtak, S., and J. Murray, “Celiac Disease in the Elderly,” Gastroenterology Clinics of North America, September 2009, Vol. 38, No. 3, pp. 433-446.
Sonders, D., et al., “Changing Face of Adult Coeliac Disease,” Postgraduate Medical Journal, January 2002, Vol. 78, No. 915, pp. 31-33.
Vilppula, Anitta, et al., “Increasing Prevalence and High Incidence of Celiac Disease in Elderly People,” BMC Gastroenterology, June 29, 2009, Vol. 9, p. 49.