Changing trends in clinical form of celiac disease. Which is now the main form of celiac disease in clinical practice?

BACKGROUND

In recent years an increased incidence of subclinical/silent celiac disease (CD) has been reported. The prevalence and clinical presentation of classical and subclinical/silent CD in 298 consecutive diagnosed celiac patients are described.

METHODS

From 1988 to 2000 we diagnosed 298 celiac patients (81 M and 217 F, mean age 27.9 yrs, range 15-65 yrs, F/M ratio: 2.4). 167 patients were referred to us due to gastrointestinal symptoms, while 131 from other specialists due to unexplained or unresponsive disease. In most of the patients (266/298) we performed sorbitol H2-breath test, while all patients underwent both total IgA and AGA/EMA evaluation, followed by gastrointestinal endoscopy with duodenal histological examination.

RESULTS

155 (52.01%) and 143 (47.98%) patients showed classical and subclinical/silent CD respectively. The prevalence of the classical form decreased from 100% (7/7 patients) in 1988 to 26.19% (14/49 patients) in 2000, while the subclinical/silent form increased from 0% (0/7 patients) in 1988 to 76.08% (35/49 patients) in 2000. The most frequent extraintestinal marker of subclinical CD were iron-deficiency anemia (25.21%), alopecia and dermatitis herpetiformis (9.56%), while first-degree relatives (35.71%), Hyperthyroidism (21.42%) and insulin-dependent diabetes (17.85%) were the most frequent in silent CD. As for malabsorption concern, it was present in 81.93% of patients with classical form, while it was present in 33.91% and in 14.28% of patients with subclinical and silent form of celiac disease respectively.

CONCLUSIONS

This study confirms the increasing occurrence of the subclinical/silent form of CD in clinical practice, which can now be considered the main form of CD. However, it is not understood what is the cause of this changing appearance in clinical practice.