WebMD Medical News
Laura J. Martin, MD
Sept 27, 2010 -- New research shows that you can develop celiac disease at any age -- even if you previously tested negative for this autoimmune intestinal disorder.
During the past 30 years, there has been a fivefold increase in the prevalence of celiac disease, and a lot of these cases occurred in elderly people, according to a study published in the Annals of Medicine.
"This has been such an unexpected result," says study researcher Alessio Fasano, MD, director of the University of Maryland's School of Medicine Center for Celiac Research and their Mucosal Biology Research Center in Baltimore. "Our impression was always that this disease began in childhood, and went under the radar screen and surfaced later on with symptoms."
Symptoms of celiac disease include abdominal cramps, constipation, diarrhea, bloating, and nausea. The disease is triggered by ingesting gluten, the protein in specific cereal grains including all types of wheat, barley, and rye. Gluten-free foods are becoming more available and accessible due to the dramatic increase in rates of celiac disease, as well as other conditions that may respond to gluten-free diets.
Researchers analyzed blood markers from more than 3,500 adults who participated in a two-part study conducted in 1974 and in 1989. They found that the incidence of celiac disease had doubled since 1974. The number of people with blood markers of celiac disease increased from one in 501 in 1974 to one in 219 in 1989, the study shows. The Celiac Disease Foundation states that one in of 133 people now have celiac disease.
The incidence of celiac disease rose as study participants aged, which is in line with a 2008 study that showed the elderly are at greater risk for developing celiac disease. These findings challenge the commonly held belief that the loss of gluten tolerance develops in childhood.
"This study says absolutely not," Fasano says. "There are situations where you can be exposed to gluten for up to 60 years, and then develop celiac disease."
"You can’t write this off at any age. Even in an elderly patient, you can't say 'it can't be celiac disease,'" he says. "If somebody tested negative for celiac disease at age 50, and then develops symptoms at age 65, test them again because you can develop gluten intolerance at any age."
Blood tests that look for the presence of certain antibodies are usually the first step in making a celiac disease diagnosis. A positive blood test is typically followed by a biopsy of the small intestine to confirm the diagnosis. This biopsy can also help assess the degree of celiac-related damage. There were no biopsy results available for the study participants.
"We are really on verge of an epidemic, and something is happening to make us more vulnerable," he says. "This is likely due to a change in environment."
The new findings may open up some new avenues for future research by allowing the investigators to work backward and determine how people can tolerate gluten for so many years, and then develop celiac disease.
"The prevalence of celiac disease appears to be increasing," says Mark Sapienza, MD, associate chief of gastroenterology at Englewood Hospital Center in New Jersey. “We need to be more aware about celiac risk in older populations."
"People may be losing their tolerance to gluten for some reason," he says. "This may be due to something in our food supply or in the environment. Just because you were screened for celiac disease 30 or 40 years ago, doesn’t that you can't develop it."
If you have risks for celiac disease and some symptoms, talk to your doctor about a celiac panel, Sapienza advises.
"The new findings highlight the importance of looking for celiac because it is more common and untreated, it causes a lot of problems," agrees Barry Zingler, MD, chief of gastoenterology at Englewood Hospital Center. Untreated celiac disease increases the risk for the brittle bone disease osteoporosis due to the body's inability to absorb calcium and vitamin D, fatigue, and certain cancers.
Not so fast, says Mel Heyman, MD, MPH, the Anita Ow Wing Endowed Chair and Professor of Pediatrics, chief of pediatric gastroenterology, hepatology, and nutrition at the University of California, San Francisco Benioff Children's Hospital.
Heyman tells WebMD that the blood test for celiac disease is not fail-safe. "We know that the test is not perfect, so some of these people could have been a false negative [in the first part of the study], which is why sometimes we go on to do a biopsy."
SOURCES:Catassi, C. Annals of Medicine, 2010.Alessio Fasano, MD, director, University of Maryland's School of Medicine Center for Celiac Research, Baltimore.Mark Sapienza, MD, associate chief, gastroenterology, Englewood Hospital Center, N.J.Barry Zingler, MD, chief, gastroenterology Englewood Hospital Center, N.J.Mel Heyman, MD, MPH, Anita Ow Wing Endowed Chair and Professor of Pediatrics; chief of pediatric gastroenterology, hepatology and nutrition, University of California, San Francisco Benioff Children's Hospital.
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