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Celiac Disease Can Develop Later in Life

Posted Oct 15 2010 7:02pm

Not only is celiac disease on the rise, but a person can develop it later in life, according to researchers at the University of Maryland School of Medicine Center for Celiac Research. Their study, published in the September issue of Annals of Medicine, debunks the myth that celiac disease begins in childhood.

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"You're not necessarily born with celiac disease," says lead author Dr. Carlo Catassi, co-director of the Center for Celiac Research . "Our findings show that some people develop celiac disease quite late in life." Catassi, also of the Universita Politecnica delle Marche in Italy, urges physicians to consider screening their elderly patients.

Celiac disease is an inherited, autoimmune condition that centers in the digestive tract. According to the National Institutes of Health, when someone with celiac disease ingests gluten (a protein found in wheat, barley and rye), his or her immune system responds by damaging or destroying villi —the tiny, fingerlike protrusions lining the small intestine that help the absorption of nutrients. Without working villi, a person becomes malnourished. Classic symptoms of celiac disease include abdominal bloating and pain, chronic diarrhea, vomiting and constipation.

In the study, Italian and American researchers tracked more than 3,500 adults using blood samples and found that the incidence of celiac disease jumped from 1 in 501 in 1974 to 1 in 219 in 1989. A 2003 study conducted by the celiac research center placed the number of people with celiac disease in the U.S. at one in 133.

The finding also contradicts the common wisdom that nothing can be done to prevent autoimmune disease. If individuals can tolerate gluten for many decades before developing celiac disease, some environmental factor or factors other than gluten must be in play, notes study co-author Dr. Alessio Fasano, director of the University of Maryland's Mucosal Biology Research Center and the celiac research center. The key is finding those other triggers.

In a Wall Street Journal Health Blog, Fasano theorizes that changes in gut bacterial ignite the disease late in life . A person might be born with a genetic predisposition to celiac disease, but that for years those genes aren't turned on. Then the gut bacteria changes, perhaps as a result of infection, surgery or antibiotics, and those genes get flipped on.

The diagnosis of celiac disease can be difficult because many patients, especially adults, who test positive for the disease may not have the classic gastrointestinal symptoms. Atypical symptoms include joint pain, chronic fatigue, seizures, depression and even an itchy skin rash called dermatitis herpetiformis. In the study, only 11 percent of the celiac patients had actually been diagnosed with the disease before the study.

According to the Celiac Disease Foundation , the only treatment is the lifelong adherence to the gluten-free diet. It means avoiding everything with wheat, barley and rye. But gluten can lurk in unexpected places: It may appear on food labels as modified food starch, preservatives or stabilizers. Gluten can also be present in everyday products such as medicines, vitamins and lip balms.

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