CHANGING PATTERN IN ADULT CELIAC-DISEASE - A 24-YEAR SURVEY

objective: To evaluate the apparent changes in the pattern of clinical expression of adult coeliac disease. Design: In order to emphasize th e influence of screening methods on diagnosis, patients were divided i n three subgroups: patients diagnosed between 1968 and 1986, those dia gnosed between 1987 and 1989, and those diagnosed between 1990 and 199 2. Results: From 1968 to 1992, coeliac disease was diagnosed in 113 ad ults; 56 of whom were diagnosed before 1986, 17 between 1987 and 1989, and 40 between 1990 and 1992. Mean age at diagnosis and male:female r atio did not change significantly in the three groups. Regarding the f requency of main presenting features, weight loss, oedema, diarrhoea, abdominal distension and hypoalbuminaemia were significantly more freq uent in the first group (P< 0.001 ). In the last two groups, abdominal pain was significantly more common. Main associated diseases were: in sulin-dependent diabetes mellitus, hypo-IgA, Down's syndrome and epile psy with cerebral calcification. Conclusions: The increased number of new diagnoses from 1987 could be ascribed both to the availability of reliable non-invasive screening tests which allow the identification o f previously unrecognized cases and to a greater awareness of the dise ase: it is not coeliac disease which is changing, but our perception o f the disease.