For a long time celiac disease (CD), an autoimmune disorder that is triggered by the consumption of gluten, was considered rare. The classic conception of celiac disease is that it begins in childhood with symptoms like diarrhea, weight loss, and malabsorption of nutrients. While this can be the case, it turns out this picture of CD is far from complete.
For one thing, CD more common than we used to believe, and the classical set of CD symptoms such as diarrhea and weight loss no longer reflects the profile of most newly-diagnosed patients, according to a new study from Italy.
Dr. Umberto Volta and his colleagues reported their review of the cases of 770 patients diagnosed with CD at St. Orsola-Malpighi Hospital in a recent study in the journal BMC Gastroenterology.1 What they found is that the clinical profile of CD has radically changed in the last 15 years.
The scientists discovered that CD is now showing up in a much wider age range than we previously realized. The majority of cases do not present with the classic symptoms of diarrhea and nutrient malabsorption. Instead they show up with “non-classical” issues like bloating, osteoporosis, and anemia. This is significant, because many clinicians still don’t even realize that CD is associated with symptoms like these. Even when classical symptoms are present, CD can be challenging to diagnose as it can be a great chameleon and masquerade as other illnesses such as the irritable bowel syndrome, Crohn’s disease and more.
CD is largely a silent process and it typically takes 6-10 years before clinicians diagnose the condition. Most concerning is the fact that only 17% of those with CD in the US have been properly diagnosed which makes it clear that too many people are unaware they even have it.
Dr. Volta and colleagues also discovered that either the incidence of CD is increasing or the rates of diagnosis are increasing as they saw a steep rise in CD in the last five years. A recent EpiCast report by an international collaboration of epidemiologists seems to suggest that CD may indeed be on the rise.2 These epidemiologists reported that the prevalence of CD is expected to increase at a growth rate of 4.61% for six major geographical populations in the US and Europe over the next 10 years. In the UK alone the prevalence of CD in children has tripled in the past 20 years.
Studies like these illustrate that CD is more common than we previously realized and that it is still frequently misunderstood. The classical conception of CD as a relatively rare pediatric food intolerance is giving way to a much more robust understanding of the condition.
Dr. Peter Green, the director of Celiac Disease Center at Columbia University, and one of the premier celiac experts in the country notes that overall, 1% of the world’s population suffers from this condition. He recently stated in an interview with Reuters, “Anyone can have celiac disease, it’s common and underdiagnosed.”3
So there is little question we are seeing a large (and probably growing) population of people who are intolerant to gluten, and when they consume the substance it can trigger not only digestive symptoms but broader systemic problems.
When to Suspect CD and When to Get Tested
Those with a family history of CD are at a higher risk of acquiring this disease. Many symptoms have been linked to CD which range from digestive discord (i.e. diarrhea, abdominal pain), neurological issues, depression, headaches, joint aches, fatigue, anemia, skin rashes, infertility and so many more.4 CD has also been linked to dozens of other related conditions including autoimmune disorders such as type I diabetes, primary biliary cirrhosis, autoimmune thyroiditis, and others.
Testing is the only sure fire method of diagnosis, so if you have any of these conditions or suspect you may have celiac disease for some other reason go to your doctor and ask to be tested. You should do this as soon as possible. The complications of CD can be severe when left untreated. For example, the condition may lead to cancer. So I advise intervention as soon as possible. This is why promoting awareness to healthcare providers and the public is so critical. It is the best measure to improve early detection and intervention of this disease which is readily curable simply by avoiding gluten.
1 Volta, U., Caio, G., Stranghellini, V. and R. De Giorgio. The changing profile of celiac disease: a 15-year experience (1998-2012) in an Italian referral center. BMC Gastroenterology. 2014. 14:194; doi:10.1186/s12876-014-0194-x.
2 Zingone, Fabiana, et al. Socioeconomic variation in the incidence of childhood coeliac disease in the UK. Archives of Disease in Childhood. 2015, Jan 22. pii: archdischild-2014-307105. doi: 10.1136/archdischild-2014-307105. [Epub ahead of print]