Coeliac disease in the elderly (original) (raw)
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Best practice & research. Clinical gastroenterology, 2002
Increased awareness of non-classical presentations and more reliable screening tests have led to higher detection rates for coeliac disease in elderly adults. Clinical presentations are influenced largely by the long-standing course of the subclinical disease before diagnosis. In the majority of elderly patients, weight loss, diarrhoea and iron deficiency anaemia are present. With a delay in diagnosis, there are increased risks of associated autoimmune diseases, of neoplasms (mostly small bowel lymphoma) and of metabolic bone diseases. Thyroid disease is the most common autoimmune disease. Lymphoma may be the initial presentation or may complicate the clinical course of well established coeliac disease. Osteopenia is very common at presentation, can be clinically severe and require specific therapy in addition to the gluten-free diet. The high risk of complications in elderly patients with coeliac disease warrants a systematic approach in their investigation and management.
The gluten-free diet and its current application in coeliac disease and dermatitis herpetiformis
United European gastroenterology journal, 2015
A gluten-free diet (GFD) is currently the only available therapy for coeliac disease (CD). We aim to review the literature on the GFD, the gluten content in naturally gluten-free (GF) and commercially available GF food, standards and legislation concerning the gluten content of foods, and the vitamins and mineral content of a GFD. We carried out a PubMed search for the following terms: Gluten, GFD and food, education, vitamins, minerals, calcium, Codex wheat starch and oats. Relevant papers were reviewed and for each topic a consensus among the authors was obtained. Patients with CD should avoid gluten and maintain a balanced diet to ensure an adequate intake of nutrients, vitamins, fibre and calcium. A GFD improves symptoms in most patients with CD. The practicalities of this however, are difficult, as (i) many processed foods are contaminated with gluten, (ii) staple GF foods are not widely available, and (iii) the GF substitutes are often expensive. Furthermore, (iv) the restrict...
Coeliac disease: a histological follow-up study
Histopathology, 2007
Aims: To assess the histological response to a glutenfree diet (GFD) in a series of coeliac patients in clinical remission, of different ages and with varying degrees of mucosal damage at diagnosis. Methods and results: Biopsy samples from 249 coeliac patients (F 165, M 84) were analysed basally and after clinical and biochemical remission following a GFD. All patients showed an improvement in mucosal findings after starting a GFD, but complete histological normalization was observed in 74.1% of paediatric cases (diagnosed before 14 years of age) and in only 17.5% of adults. Statistical analysis showed that sex, the clinical picture at diagnosis and the length of time between biopsy at the time of diagnosis and on a GFD were not related to histological normalization. In contrast, the age at diagnosis was statistically significantly related to it (P < 0.0001). In addition, the presence ⁄ absence of Helicobacter pylori was independent of the normalization of the duodenal mucosa. Conclusions: In clinical practice the criteria for diagnosis of coeliac disease are sufficiently standardized, whereas for follow-up they are less well defined. We suggest that in order to compare the results from different studies, it should be stated whether remission after treatment is based on clinical or histological criteria or both.
2014
and the USA) reviewed the literature on diagnosis and management of adult coeliac disease (CD). This paper presents the recommendations of the British Society of Gastroenterology. Areas of controversies were explored through phone meetings and web surveys. Nine working groups examined the following areas of CD diagnosis and management: classification of CD; genetics and immunology; diagnostics; serology and endoscopy; follow-up; gluten-free diet; refractory CD and malignancies; quality of life; novel treatments; patient support; and screening for CD.
A strict gluten free diet (GFD) is the only treatment of coeliac disease (CD). However, compliance with such a diet has an impact on the quality of life of individuals with CD, and, possibly, on their nutritional status. The aim of the study was to assess the dietary intake of female coeliacs and to determine if they are meeting the current dietary reference values. Volunteers were recruited through advertisements placed in coeliac disease support groups, and from the Section of Dietary Counseling at the Department of Dietetics at WUL-S. Forty-two volunteers met all criteria for participation and completed the 3-day food records. The following parameters were evaluated: body height, weight, mass index, and fat and muscle masses (bioimpedance -BIA, Akern). The total daily energy and selected nutrients intake were calculated using Dietetyk 1 software, and the obtained values were compared to current recommendations. The results showed an inadequate intake of complex carbohydrates, i bre, calcium, potassium and iron, and high consumption of fat, sugar, and phosphorus. Although most of the individuals (79%) had normal weight, the BIA results showed excessive amount of fat tissue. Female CD patients are at risk of having an unbalanced diet; therefore, the nutritional therapy for CD patients cannot be focused only on the avoidance of gluten on a GFD. Emphasis should be on the nutrients contents of a gluten-free foods, especially fat, sugar, i bre, calcium, potassium, and iron.
A clinicopathological approach to the diagnosis of coeliac disease
Diagnostic Histopathology, 2012
Coeliac disease is defined as a small bowel enteropathy due to immune mediated damage on exposure to gluten in the diet, occurring in those with a genetic predisposition to this condition. Previously considered rare, the prevalence of coeliac disease is increasing due to a genuine rise in incidence and also better detection. The diagnosis of coeliac disease involves many disciplines, presentation is varied and if the diagnosis is delayed there is a risk of poor quality of life and a small increase in malignancy. Serology is a first line test, followed by confirmatory small intestinal biopsy. This review discusses the clinicopathological approach to diagnosis, through serology and biopsy and discusses complications which occur in some individuals, namely refractory coeliac disease and dermatitis herpetiformis. The entity of non-coeliac gluten sensitivity is also entering the spectrum of coeliac diagnosis and may lead to an extension of the diagnostic parameters of coeliac disease.
Analysis and clinical effects of gluten in coeliac disease
European journal of …, 2001
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