Adult celiac disease: importance of delay to diagnosis

OBJECTIVE: Adult celiac disease is a genetically determined condition resul ting from intolerance to gluten. This familial disease is associated with H LA B8 DR3 and is characterized by cytotoxic T-lymphocyte reaction in the di gestive wall leading to a maladsorption syndrome. Adult celiac disease woul d be an expression of a silent disease already present in childhood. PATIENTS AND METHODS: We conducted a retrospective study in 19 patients. Di agnosis was established in a department of internal medicine in adulthood. We analyzed histological findings and the clinical history and course. RESULTS: The age curve at diagnosis peaked at 22 years and 67 years. Female sex predominated. Average delay to diagnosis was 3.1 years. The patients w ere admitted for reasons other than digestive disorders in 17 out of 1.9 ca ses. Careful history taking did however disclose subtle digestive signs. Th e principal manifestations wee hematological disorders such as chronic anem ia, abnormal liver function tests, and poor control of associated diseases. Type 1 diabetes mellitus was the main associated disease (4/19). Patients with prolonged nutritional deficiencies experienced serious situations. CONCLUSION: Adult celiac disease is a clinical Variant suggesting the prese nce of other non-digestive disorders. Specific antibodies should be assayed in patients with even minimal signs of deficiency in order to identify ass ociated diseases. The principal cause of mortality is digestive T-cell lymp homa. A gluten-free diet is essential to control the course of this chronic disease.