Trends in the presentation of celiac disease

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. (C) 2006 Elsevier Inc. All rights reserved.