Elderly Onset Celiac Disease: A Narrative Review

Maria Cappello, Gaetano C Morreale, Anna Licata, Maria Cappello, Gaetano C Morreale, Anna Licata

Abstract

Celiac sprue is a chronic disease, which usually occurs in children and young adults. However, it can develop in any age group, and the prevalence is increasing even in the elderly population. The atypical patterns of clinical presentation in this age group sometimes can cause a delay in diagnosis. Given the lower sensitivity and specificity of serological tests in the aged population, clinical suspect often arises in the presence of complications (autoimmune disorders, fractures, and finally, malignancy) and must be supported by endoscopic and imaging tools. In this review, we highlight the incidence and prevalence of celiac disease in the elderly, the patterns of clinical presentation, diagnosis, and the most frequent complications, with the aim of increasing awareness and reducing the diagnostic delay of celiac disease even in the elderly population.

Keywords: cardiovascular risk; celiac disease; elderly; presentations.

Figures

Figure 1
Figure 1
Endoscopic duodenal view of a 73-year-old patient with RCD.
Figure 2
Figure 2
RCD in the 73-year-old patient: small intestinal mucosal biopsy with frank villous atrophy, showing mild chronic inflammatory infiltrate and some eosinophils in the lamina propria (A/B; hematoxylin/eosin 20× and 40×); CD3 immunostaining highlights an increased number of intraepithelial CD3+ lymphocytes (C/D 20× and 40×).
Figure 3
Figure 3
CT scan showing wall thickening of some jejunal loops (arrows) with associated hyperdensity of mesenteric fat of a CD patient with T-cell lymphoma, anaplastic large cells. EATL was initially diagnosed in 2009, when the patient underwent surgery because of obstruction. At this time, diagnosis of CD was not established for limited extension of mucosal damage on the surgical specimen, although the high level of clinical suspicion (but negative serology). Six years later, during follow-up, a new endoscopy was performed and finally a diagnosis of CD was formulated (small intestinal mucosal biopsy showed Marsh 3B; intraepithelial lymphocytes (CD3+) >25/100).

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