Celiac Disease: A Forty-Year Analysis in an Italian Referral Center

[helvella]

Not sure there is anything actually new here - but the statistics are far more significant than I had realised.

(Of course, many here have some of these associated co-morbidities and complications despite having been tested properly and not having celiac disease.)

Celiac Disease: A Forty-Year Analysis in an Italian Referral Center

Abstract

Background: Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion. Herein, we assessed clinical, serological and histopathological findings of a single-center, large cohort of CD patients diagnosed and followed-up over forty years.

Methods: From January 1980 to December 2020, 1547 CD patients (1170 females; age range: 8-81 years; F:M ratio = 3.1:1) were diagnosed in an Italian tertiary referral center. Comorbidities and complications were recorded at diagnosis and during follow-up.

Results: CD diagnoses quadrupled after 2000. The most frequent phenotype was the non-classical CD (63.3%), and the most prevalent histotype was Marsh 3C (44.7%). Gastrointestinal manifestations, detectable in 51% of patients, were diarrhea (24.3%), bloating (28%) and aphthous stomatitis (19.7%). The most common CD-associated disorder was osteopenia (59.9%), predominant in females (64.3%); extraintestinal manifestations included anemia (35.8% iron-deficiency; 87% folic acid malabsorption), cryptogenic hypertransaminasemia (27.9%), and recurrent miscarriages (11.5%). Thyroiditis (26.9%), type 1 diabetes mellitus (2.9%), and dermatitis herpetiformis (1.4%) were the most common CD-related autoimmune disorders. Six patients had inflammatory bowel disease. Complications and mortality rate occurred in 1.8% and 1.9%, respectively.

Conclusions: This single-center, large cohort analysis confirmed that CD presentation changed over the years, with an increase of non-classical and subclinical clinical phenotypes.

Keywords: celiac disease; clinical features; natural history; osteoporosis; refractory celiac disease.

Open access here:

mdpi.com/2072-6643/16/14/2292

[SlowDragon Administrator]

very very interesting

Especially

cryptogenic hypertransaminasemia (27.9%),

pubmed.ncbi.nlm.nih.gov/240...

Thyroiditis (26.9%)

And

87% folic acid malabsorption

[helvella Administrator Thyroid UK in reply to SlowDragon]

I thought the folic acid malabsorption issue might well be a factor regarding the 5 milligram doses that have proved controversial (especially on Pernicious Anaemia Society).

If you have poor absorption, a dose as high as 5 milligrams might be needed to actually absorb a fairly unexceptional amount.

But if you have good absorption, then such a high dose might take you straight into the problem overdose issues.

And there is nothing to clarify whether other forms of folate (methylfolate and folinic acid) are similarly affected.

Nor is there much clarity about whether the autoimmune gastritis has a similar impact on folic acid absorption - even in those who do not have coeliac disease.

Hence, patients are left somewhat in the lurch.

[SlowDragon Administrator in reply to helvella]

this one is particularly interesting

Celiac disease hidden by cryptogenic hypertransaminasemia

Never heard of cryptogenic hypertransaminasemia before

It is now well recognised that its onset may occur at any age and that atypical forms of CD are much more prevalent than its classic form (1).In this case, where the patient presented with high BMI and evidence of grade I of fatty liver disease, CD was suspected due to mildly abnormal bloating, cryptogenic hypertransaminasemia, abnormal LFT and poor response to fatty liver treatment. This presentation type is not uncommon; diagnosis was confirmed by the presence of subtotal villous atrophy in the biopsy specimen, positive specific antibody screening (AGA, tTG and EMA antibodies), negative antibody screening and normalization of liver enzymes on a gluten-free diet (Tab. 2, Ref. 13).

Some Medics still often think coeliac is not possible unless skinny and struggling to maintain weight