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Elderly people more likely to develop coeliac disease than children

A new study from University of Maryland's Mucosal Biology Research Center and Center for Celiac Research, working with three other university research centres in the US and Italy, has found that, contrary to the common belief that coeliac disease develops in childhood, as people age the incidence of the disease increases, the prevalence in the elderly being nearly two and half times greater than that in the general population.

Since 1974, in the US, the incidence of the disorder has doubled every 15 years. Using blood samples from more than 3,500 adults, the researchers found that the number of people with blood markers for coeliac disease increased steadily from one in 501 in 1974 to one in 219 in 1989. In 2003, a widely cited study conducted by the Center for Celiac Research placed the number of people with celiac disease in the U.S. at one in 133.

As the people in the study aged, the incidence of celiac disease rose, echoing the findings of a 2008 Finnish study in Digestive and Liver Disease that found the prevalence of coeliac disease in the elderly to be nearly two and a half times higher than the general population.

Although researchers have identified specific genetic markers for the development of coeliac disease, exactly how and why an individual loses tolerance to gluten remains a mystery. ‘Even if you have these genetic markers, it's not your destiny to develop an autoimmune disease,’ says Dr Alessandro Fasano, director of the University of Maryland Center. ‘Our study shows that environmental factors cause an individual's immune system to lose tolerance to gluten, given the fact that genetics was not a factor in our study since we followed the same individuals over time.’

The finding contradicts the common wisdom that nothing can be done to prevent autoimmune disease unless the triggers that cause autoimmunity are identified and removed. Gluten is one of the triggers for coeliac disease. But if individuals can tolerate gluten for many decades before developing celiac disease, some environmental factor or factors other than gluten must be in play.

However, diagnosis of coeliac disease remains a challenge as patients who test positive for the disease may not display the classic symptoms of gastrointestinal distress linked to the disease. Atypical symptoms include joint pain, chronic fatigue and depression. In the study, only 11% of people identified as positive for coeliac disease autoimmunity through blood samples had actually been diagnosed with the disease.

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Annals of Medicine. Natural history of celiac disease autoimmunity in a USA cohort followed since 1974


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