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Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Dec 7, 2008; 14(45): 6911-6914
Published online Dec 7, 2008. doi: 10.3748/wjg.14.6911
Adult celiac disease in the elderly
Hugh James Freeman
Hugh James Freeman, Department of Medicine (Gastroentero-logy), University of British Columbia, Vancouver, BC V6T 1W5, Canada
Author contributions: Freeman HJ contributed all to this paper.
Correspondence to: Hugh James Freeman, MD, CM, FRCPC, FACP, Department of Medicine (Gastroenterology), University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC V6T 1W5, Canada. hugfree@shaw.ca
Telephone: +1-604-8227216 Fax: +1-604-8227236
Received: October 16, 2008
Revised: November 10, 2008
Accepted: November 17, 2008
Published online: December 7, 2008
Abstract

There is an increased awareness that celiac disease may occur in the elderly although presentations with either diarrhea, weight loss or both may be less common causing delays in diagnosis for prolonged periods. Higher detection rates also seem evident owing to active case screening, largely through serodiagnostic measures. In some elderly patients who are genetically predisposed, it has been hypothesized that celiac disease might be precipitated late in life by an antigen, possibly from an infectious agent. As a result, peptide mimicry or other poorly-defined mechanisms may precipitate an autoimmune gluten-dependent clinical state. Although diarrhea and weight loss occur, only isolated iron deficiency anemia may be present at the time of initial diagnosis. In addition, the risk of other autoimmune disorders, particularly autoimmune thyroiditis, and bone disease, are increased. Osteopenia may also be associated with an increased risk of fractures. Finally, elderly celiacs have an increased risk of malignant intestinal disease, especially lymphoma.

Keywords: Celiac disease; Elderly; Lymphoma; Silent celiac disease