Trends in the presentation of celiac disease

Am J Med. 2006 Apr;119(4):355.e9-14. doi: 10.1016/j.amjmed.2005.08.044.


Purpose: Screening studies have revealed that celiac disease is common in the United States; however, there are scant data on the mode of presentation. We analyzed the trends in clinical presentation over the last 52 years in a large cohort of biopsy-proven patients seen in 1 center.

Subjects and methods: Patients (n = 590) were divided into 6 groups based on the year of diagnosis (1952-2004). Groups were compared for trends in age at diagnosis, childhood diagnosis, duration of symptoms, mode of presentation (diarrhea, bone disease, anemia, incidental at esophagogastroduodenoscopy, screening), and presence of malignancy.

Results: Diagnosis was at an older age since 1980 (P = .007), and there was a significant negative linear trend in patients presenting with diarrhea (P<.001) over time and a positive linear trend in asymptomatic patients detected on screening (P<.001). There was a significant negative linear trend in patients with a malignancy (P = .02) and duration of symptoms before diagnosis of celiac disease (P = .001), although only the subgroup without diarrhea had improvement in delay of diagnosis of celiac disease (assessed by a shorter duration of symptoms) (P = .05). Comparison of patients with and without diarrhea showed no significant difference in age (42.9 years vs 43.7 years, P = .59), gender (29.3% M vs 34.6%, P = .59), and presence of childhood disease (8.0% vs 9.8%, P = .43) or malignancies (9.8% vs 8.9%, P = .71).

Conclusion: There is a trend toward fewer patients presenting with symptomatic celiac disease characterized by diarrhea and a significant shift toward more patients presenting as asymptomatic adults detected at screening.

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Aged
  • Aged, 80 and over
  • Anemia, Hypochromic / etiology
  • Bone Diseases, Metabolic / etiology
  • Celiac Disease / complications
  • Celiac Disease / diagnosis*
  • Celiac Disease / epidemiology*
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Diarrhea / etiology
  • Endoscopy, Digestive System
  • Female
  • Gastrointestinal Neoplasms / complications
  • Humans
  • Incidental Findings
  • Linear Models
  • Male
  • Middle Aged
  • Retrospective Studies
  • Sex Distribution
  • Time Factors
  • United States / epidemiology


  • Cholesterol, HDL
  • Cholesterol, LDL