Age-related differences in celiac disease: Specific characteristics of adult presentation

Table 1 Age-related major clinical findings at celiac disease diagnosis

Children < 2 yr	Children > 2 yr	Adults
Diarrhea	Loose stools	Dyspepsia/irritable bowel syndrome
Malnutrition	Iron deficiency	Iron deficiency
Bloating	Abdominal pain	Constipation
Vomiting	Dyspepsia	Osteoporosis
Irritability	Growth delay	Arthritis
Muscular atrophy	Headache	Hypertransaminasemia
Anemia	Pubertal delay	Extraintestinal symptoms

Table 2 Diagnostic criteria for celiac disease proposed by Catassi and Fasano[22]

The presence of signs and symptoms compatible with celiac disease

Positivity of serum celiac disease IgA class autoantibodies at high titer

Presence of the predisposing genes HLA-DQ2 and/or -DQ8

Celiac enteropathy at the small intestinal biopsy1

Resolution of the symptoms and normalization of serology test following the implementation of a gluten-free diet2

¹Including Marsh-Oberhuber 3 lesions, Marsh-Oberhuber 1-2 lesions associated with positive celiac antibodies positive at low/high titer, or Marsh-Oberhuber 1-3 lesion associated with IgA subepithelial deposits;

²Histological normalization in patients with sero-negative celiac disease or associated IgA deficiency. At least 4 of 5 (or 3 of 4 if the HLA genotype is not performed). HLA: Human leukocyte antigen.

Table 3 Summary of key features associated with the presentation of celiac disease in adults

High prevalence, even in advanced age

Oligosymptomatic presentation

Serology may have a low diagnostic yield

Duodenal biopsy usually shows mild atrophy or lymphocytic enteritis

Lymphocytic enteritis is a common presentation in adult celiac

The study of duodenal biopsy by an expert pathologist and the use of advanced techniques like flow cytometry may be useful for the diagnosis

Monitoring of the strict dietary compliance and the recovery of villous atrophy

The presence of associated complications should be identified at an early stage