Celiac disease in the elderly: clinical, serological and histological characteristics, and effect of gluten free diet

Background/objectives. Little information is available on clinical presentation and on response to gluten free diet (GFD) in old patients. The aim of the study was to characterize celiac disease (CD) in older by comparison with younger patients, and to assess the effects GFD.
Design. Retrospective retrieval of information prospectively fed to a structured data-base.
Setting. CD Clinic, University and Spedali Civili. Brescia, Italy
Participants. Two cohorts were identified: older (group A; n=59, age >65 years) and younger patients (group B; n=1166, age 18-64 years), further sub-grouped B1, (n=600, age 18-34 years), B2 (n=440, age 35-49 years) and B3 (n=26, age 50-64 years).
Measurements. clinical, serological and histological characteristics of CD patients studied before and during GFD
Results. At presentation, prevalence of weight loss (37% Vs 21%, p=0.005) and dyspepsia (22% Vs 12%, p=0.04) were more frequent in older than younger patients. Incidence at diagnosis of Non-Hodgkin Lymphoma (NHL) was much higher in older (5%) than younger patients (0.3%, p=0.003). Prevalence of osteoporosis was 67% Vs 14% and 70% Vs 9% (p<0.0001) in older Vs younger male and female patients, respectively. During treatment compliance to GFD was 90%, normal villous structure was reconstituted and t-transglutaminase antibodies were negative in 80% in both older and younger patient. Lumbar-sacral and femoral T score increased significantly during GFD in pooled results of 48 older and younger patients studied before and during GFD.
Conclusions. NHL is already present at CD diagnosis almost exclusively in patients older than 50 years, emphasizing the importance of early diagnosis. Older and younger patients are equally adherent and equally benefit of GFD indicating that old age is not a barrier to dietary treatment.