Celiac dis­ease can de­velop in adults

Los Angeles Times - - The Nation - Jeannine Stein jeannine.stein@latimes.com

Cases of celiac dis­ease may be on the rise, in large part be­cause peo­ple can de­velop the au­toim­mune dis­or­der much later in life than pre­vi­ously thought, ac­cord­ing to a study pub­lished Mon­day in the An­nals of Medicine.

The preva­lence of the dis­ease more than dou­bled among a group of 3,511 seem­ingly healthy adults be­tween 1974 and 1989, re­searchers found. By retest­ing blood sam­ples col­lected decades ago, they also de­ter­mined that 15 of the 16 peo­ple who had celiac dis­ease were not di­ag­nosed at the time.

The find­ings should prompt physi­cians and sci­en­tists to re­ex­am­ine some of their fun­da­men­tal as­sump­tions about the dis­or­der.

“A lot of those rules of thumb have to be reeval­u­ated as we learn more about it and we find pa­tients de­vel­op­ing the dis­ease later in life,” said Dr. Eric Es­rail­ian, a gas­troen­terol­o­gist at UCLA’s David Gef­fen School of Medicine, who wasn’t in­volved in the study.

Celiac dis­ease is a di­ges­tive con­di­tion trig­gered by eat­ing foods that con­tain gluten, an es­sen­tial pro­tein found in grains like wheat, bar­ley and rye.

In those af­fected, gluten prompts the im­mune sys­tem to de­stroy the lin­ing of the small in­tes­tine, which pre­vents peo­ple from ab­sorb­ing the nu­tri­ents in food and leaves them at risk of mal­nour­ish­ment. Symp­toms in­clude di­ar­rhea, weight loss, con­sti­pa­tion, ane­mia and fa­tigue. An es­ti­mated 1 in 133 peo­ple in the U.S. has the dis­ease.

Re­searchers had thought celiac dis­ease could de­velop only dur­ing child­hood. It didn’t seem pos­si­ble that peo­ple could eat gluten with no prob­lems for decades and then sud­denly lose their abil­ity to tol­er­ate it.

But that’s ex­actly what re­searchers from the Cen­ter for Celiac Re­search at the Uni­ver­sity of Mary­land School of Medicine and their col­leagues found.

They pig­gy­backed on a study de­signed to iden­tify risk fac­tors for can­cer and heart dis­ease. Par­tic­i­pants pro­vided health in­for­ma­tion and blood sam­ples in 1974 and again in 1989. The re­searchers tested those blood sam­ples for biomark­ers re­lated to celiac dis­ease. They found that seven had the con­di­tion in 1974, none of whom had been di­ag­nosed. By 1989, the num­ber of cases had risen to 16, though only one had been di­ag­nosed.

Over­all, the preva­lence of the dis­ease more than dou­bled from 0.21% to 0.45%, the re­searchers re­ported. At least two peo­ple de­vel­oped the dis­or­der af­ter they turned 50.

“We were shocked,” said Dr. Alessio Fasano, the pe­di­a­tri­cian who led the study.

What causes late on­set of celiac dis­ease isn’t known. Peo­ple must have a ge­netic pre­dis­po­si­tion to it, but sci­en­tists aren’t sure why gluten in­tol­er­ance would de­velop af­ter so many trou­ble­free years.

Fasano said en­vi­ron­men­tal fac­tors could trig­ger changes in the im­mune sys­tem that might ac­ti­vate the anti-gluten gene, but iden­ti­fy­ing those fac­tors won’t be easy.

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