There was a female-to-male predominance of 3 to 1. The age at diagnosis ranged from 1 to 90 y, with a median of 48 y. The disease was diagnosed in the 215 patients between 19 the disease was diagnosed in 195 of the patients after 1990 and in 188 of the patients after 1995. These patients were seen at a single institution in the upper-midwestern region of the United States. All the patients had an intestinal biopsy specimen compatible with celiac disease and a clinical response to a gluten-free diet. The study population consisted of 215 patients in whom celiac disease was diagnosed according to internationally accepted criteria ( 11). SUBJECTS AND METHODS A systematic survey of subjects with diagnosed celiac disease The aims of the present study were to identify the frequency and nature of gastrointestinal symptoms in a large cohort of patients with diagnosed celiac disease and to determine the effect of a gluten-free diet on these symptoms. There are few detailed reports of the effectiveness of a gluten-free diet on these atypical symptoms. Patients who have so-called atypical presentations seem to be at least as common as are those with the classic syndrome. The European experience with celiac disease has provided a perspective that illustrates a broad spectrum of modes of presentation of the disorder and the frequency of monosymptomatic presentation rather than the classic presentation of malabsorptive symptoms ( 5– 10). A serum survey of anonymous US blood donors found a high frequency of markers for covert celiac disease ( 4). Subtle presentations of celiac disease were first described > 30 y ago ( 3). The classic syndrome of celiac disease as originally described by Gee ( 2) consists of steatorrhea, diarrhea, and weight loss in adults and failure to thrive in children and evidence of overt nutritional deficiencies due to small-bowel malabsorption. With a gluten-free diet, patients have substantial and rapid improvement of symptoms, including symptoms other than the typical ones of diarrhea, steatorrhea, and weight loss.Ĭeliac disease, gluten-free diet, abdominal pain, enteropathy, irritable bowel syndrome INTRODUCTIONĬeliac disease, otherwise known as gluten-sensitive enteropathy, is considered a rare disease in the United States ( 1). Clinicians must have a high level of suspicion to detect the atypical forms of celiac disease. Most patients had abdominal pain and bloating, which resolved with the diet.Ĭonclusions: Celiac disease causes a wide range of gastrointestinal symptoms. Many patients had alternating diarrhea and constipation, both of which were responsive to the gluten-free diet. Diarrhea responded in most patients, usually within days, and the mean time to resolution was 4 wk. The benefit of gluten exclusion was equally apparent in men and women. Other complaints were common, and most responded to gluten exclusion. Although diarrhea was the most frequent symptom in untreated celiac disease, steatorrhea occurred in only one-fifth of patients. Results: The group consisted of 160 female and 55 male patients. The systematic survey asked detailed questions regarding gastrointestinal symptoms before and after the institution of a gluten-free diet in the patients, all of whom had been given the same dietary advice. Objective: We examined the effect of a gluten-free diet on gastrointestinal symptoms in a cohort of US patients with celiac disease.ĭesign: A follow-up survey was conducted in 215 patients who were evaluated at the University of Iowa from 1990 through 1997 as having biopsy-confirmed celiac disease. Background: Atypical presentations of celiac disease appear to be at least as common as is the classic presentation of steatorrhea, diarrhea, and weight loss.
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