Coeliac disease in the elderly - A multicentre Italian study

Background. In the last few decades, we have observed either an increased i ncidence of coeliac disease (CD) or an increased frequency of its diagnosis . However, only scant information is available about the prevalence and cli nical features of CD in the elderly. Aim of the Study. To determine the pro portion of elderly patients (age greater than or equal to 65 years) in a la rge group of consecutive newly-diagnosed cases of adult CID and to analyze the clinical pattern and causes of death. Patients and Methods: 1,353 adult patients with active CID were diagnosed by 10 Italian Gastroenterology Uni ts over a period of 10 years. For each patient, a questionnaire comprising demographic data, signs and symptoms with their duration at the moment of t he diagnosis, and associated diseases or complications and the causes of de ath, was drawn up. Results: A total of 60 patients (4.4%) were over 65 year s at diagnosis with a M/F ratio of 1/2.75 which was similar to 1/2.42 in th e under-65-year age group. The mean time of delayed diagnosis was 17 +/- 19 years in the elderly and 14 +/- 13.8 years in the adults. Classical featur es of malabsorption were the main presenting symptoms and gastrointestinal disorders were very often also present in the geriatric patients. Twelve ag ed subjects (20%) died during the follow-up period (mean 4.6 years) often d ue to cachexia (5%) and heart failure (5%), even though complications such as intestinal lymphoma were present in 8.3% of cases and caused death in 3. 3% of the elderly. Conclusions: In spite of classical manifestations of CID in the elderly, the diagnosis was made in only 4.4% of subjects aged over 65 years and the delay was 17 years. These observations, together with the shortening of life expectancy of elderly CD patients, emphasize the importa nce for clinicians to consider CD as a possible diagnosis and the need for further investigations to be carried out in the elderly general population. Copyright (C) 2001 S. Karger AG, Basel.