Celiac Disease in the Elderly

Celiac.com 02/13/2012 - Evidence from numerous epidemiological studies supports the idea that celiac disease is not a disease that largely affects children, but is actually a disease that can affect people of any age.  Several recent studies suggested that a majority of patients are now diagnosed after age 50.

Indeed, in one study, the median age at diagnosis was just short of age 50, with one-third of new patients diagnosed over the age of 65. A recent study in Finland found even a higher prevalence of biopsy-proven celiac disease (2.13%) in older people (52-74 years of age).

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Another recent study showed that celiac disease may truly occur for the first time in an elderly individual, despite a life-long apparent tolerance of gluten ingestion, not merely be diagnosed at this age. However, despite growing body of research on celiac disease, very little is known about this condition in older people.

A research team set out to review the prevalence, clinical features, diagnosis and consequences of celiac disease in the elderly. The team included Shadi Rashtak, MD and Joseph A. Murray, MD, affiliated with the Department of Medicine, Division of Gastroenterology and Hepatology, and the Department of Dermatology at the Mayo Clinic College of Medicine in Rochester, Minnesota

They also reviewed data on treatment strategies for celiac disease, with emphasis on the particular nutritional and non-nutritional consequences or connections there may regarding celiac disease in the elderly.

Part of the problem is that lack of awareness, coupled with more atypical symptoms in older celiac patients, as compared to the younger patients, can result in delayed diagnosis of celiac disease in this population which leads to higher morbidity and mortality in this group.

Also, classic symptoms of celiac disease, such as diarrhea, weight loss and abdominal pain are less common in elderly celiac patients. Even though many elderly celiac patients do have abdominal symptoms, many have milder symptoms, such as abdominal bloating, flatulence, and abdominal discomfort, which make proper diagnosis more difficult.

The team also notes that celiac disease is the most common cause of steatorrhea in people over 50 years of age, and the second most common cause in those over 65 years.

Between 60% and 80% of older people with celiac disease suffer from anemia, which is largely attributed to a deficiency of micronutrients, mainly iron.

The presence of other autoimmune diseases that are frequently associated with celiac disease may well offer important clues that can raise possibility of celiac disease in an elderly patient.

For example, autoimmune thyroid disorders are commonly associated with autoimmune diseases in elderly celiac patients, with majority of patients suffering from hypothyroidism. Also, the risk of intestinal lymphoma and other celiac disease-associated malignancies is higher in older people.

Occasionally, celiac disease may present with cavitation of mesenteric lymph nodes and splenic atrophy or with intestinal ulceration with or without underlying malignancy

In the face of this data, the team is calling for improved awareness of the incidence and clinical presentation of celiac disease in the elderly to prevent delays in diagnosis.

Even though treatment for celiac disease is pretty basic, the elderly may face individual treatment challenges, especially with regard to making radical dietary changes, and also in coping with the difficulties of chronic nutritional absorption problems.

The researchers feel that a comprehensive, multidisciplinary approach to treating celiac disease should reduce patient deaths related to celiac disease, and emphasize that a treatment approach tailored to the individual challenges of each elderly celiac patients is the key to success.

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