Diagnosing celiac disease in the elderly: A United Kingdom cohort study

Aim –To assess whether there are benefits to diagnosing CD in an elderly population compared to younger adults.Background – Coeliac disease in the elderly has been underdiagnosed due to the heterogeneity of presentation as well as lack of physician awareness of CD in this population. However, the benefits of diagnosing CD in the elderly may be contentious.Methods – Newly diagnosed CD patients were prospectively recruited from the Coeliac Specialist Clinic at the Royal Hallamshire Hospital, Sheffield, between 2008 and 2017. All patients had villous atrophy (VA) on biopsy with positive coeliac serology. Additionally, patients were retrospectively recruited from 1990 to 2008 to determine the trend in elderly CD diagnostic frequency over time.Results – 1605 patients with CD were recruited (n=644 prospectively, n=961 retrospectively). Of these, 208 patients (13.0%) were diagnosed over the age of 65 years between 1990 and 2017. The proportion of elderly CD diagnoses increased from 0% in 1990-1991 to 18.7% in 2016-2017 (p<0.001). Younger patients more commonly presented with fatigue (p<0.001) and gastrointestinal symptoms including diarrhoea (p=0.005), abdominal pain (p=0.019), and IBS-type symptoms (p=0.008), Older people more frequently presented with B12 deficiency (p=0.037) and had partial VA (24%) compared to younger patients (16.5%) (p=0.005).Conclusion –The prevalence of CD in the elderly has significantly increased over the last two decades but elderly patients tend to present with fewer symptoms and a milder degree of VA. Further research is needed to determine whether a strict gluten-free diet in these patients is a necessity or a burden.