Non-classical clinical presentation at diagnosis by male celiac disease patients of older age |
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| Institution: | 1. Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, 9700 RB Groningen, Groningen, the Netherlands;2. Department of Genetics, University of Groningen and University Medical Center Groningen, 9700 RB Groningen, Groningen, the Netherlands;3. Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, 7500 KA Enschede, the Netherlands;1. Department of Medical & Surgical Sciences, University of Foggia, Italy;2. U.O.C. Cardiologia, Ospedale San Paolo, Bari, Italy;3. Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy;1. Cardiothoracic Department, ASST Spedali Civili di Brescia University of Brescia, Brescia, Italy;2. Department of Medical Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy;1. European Medicines Agency (EMA), Amsterdam, The Netherlands;2. EMA, Amsterdam, The Netherlands and London School of Hygiene and Tropical Medicine, London, UK;3. EMA, Amsterdam, The Netherlands, and Medical University of Vienna, Vienna, Austria;4. European Medicines Agency (EMA), Amsterdam, The Netherlands;5. Medicines Evaluation Board (MEB), Utrecht, The Netherlands and EMA Pharmacovigilance and Risk Assessment Committee (PRAC), Amsterdam, The Netherlands;6. EMA, Amsterdam, The Netherlands, and University Tor Vergata, Rome, Italy;1. Department of Medicine and Ageing Sciences, University G. D''Annunzio, Chieti-Pescara, Italy;2. Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands;3. Department of Internal Medicine, \"G. D''Annunzio\" University, Chieti, Italy;4. Respiratory Medicine Unit, Pescara General Hospital, Pescara, Italy;5. Internal Medicine Unit, Pescara General Hospital, Pescara, Italy;6. Geriatric Medicine Unit, Pescara General Hospital, Pescara, Italy;7. Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy;8. Cardiometabolic Programme, National Institute for Health Research University College London Hospitals (UCLH) Biomedical Research Centre, Department of Medicine, UCLH National Health Service Foundation Trust, London NW1 2PG, UK;9. Department of Medical, Oral and Biotechnological Sciences, \"G. D''Annunzio\" University, Chieti, Italy;1. Division of Cardiology, Ospedale degli Infermi, ASL, Biella, Italy;2. Department of Translational Medicine, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, C.so Mazzini, 18, 28100 Novara, Italy;3. Department of Cardiology, UMC St Radboud, Nijmegen, the Netherlands |
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| Abstract: | Background. In a biopsy-proven adult celiac disease (CeD) cohort from the Netherlands, male patients were diagnosed with CeD at significantly older ages than female patients.ObjectivesTo identify which factors contribute to diagnosis later in life and whether diagnostic delay influences improvement of symptoms after starting a gluten-free diet (GFD).Methods. We performed a questionnaire study in 211 CeD patients (67:144, male:female) with median age at diagnosis of 41.8 years (interquartile range: 25–58) and at least Marsh 2 histology.Results. Classical symptoms (diarrhea, fatigue, abdominal pain and/or weight loss) were more frequent in women than men, but sex was not significantly associated with age at diagnosis. In a multivariate analysis, a non-classical presentation (without any classical symptoms) and a negative family history of CeD were significant predictors of older age at diagnosis (coefficients of 8 and 12 years, respectively). A delay of >3 years between first symptom and diagnosis was associated with slower improvement of symptoms after start of GFD, but not with sex, presentation of classical symptoms or age at diagnosis.Conclusion. Non-classical CeD presentation is more prevalent in men and is associated with a diagnosis of CeD later in life. Recognizing CeD sooner after onset of symptoms is important because a long diagnostic delay is associated with a slower improvement of symptoms after starting a GFD. |
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