Diagnosing Celiac Disease: From Paediatrics to Geriatrics
Dr. Mohsin Rashid MBBS, MEd, FRCP(C)
Faculty of Medicine, Dalhousie University
Member, Professional Advisory Board
Medical Advisor, CCA Halifax Chapter
Canadian Celiac Association
A twelve year-old boy was diagnosed with celiac disease at our gastroenterology clinic. The diagnosis was confirmed with a small intestinal biopsy. Since celiac disease is a familial disorder, serological (blood test) screening of first and second-degree relatives was recommended. The next time I met the patient in follow-up, we were informed that the 71 year-old grandma was found to have celiac disease!
Celiac disease occurs in genetically susceptible individuals. It occurs in both sexes. The disease can present at any age once the individual starts to take gluten. This is usually from six months onwards, a time when solids are introduced in the infant’s diet. What remains unclear is that with the same genetic susceptibility why the disease develops at six months of age in some and at sixty years in others. Clearly, there are other undefined genetic and environmental factors at play. Sometimes physical stress triggers celiac disease. This includes conditions like a gastrointestinal infection, surgery, pregnancy, trauma, etc. Even emotional stress has been considered to be a trigger.
Traditionally, celiac disease has been considered a paediatric disorder. Part of the reason is that most pioneer physicians in this area have been paediatricians. Dr. Samuel Gee who gave the first modern-day written description of celiac disease from St. Bartholomew’s Hospital in 1888 was a paediatrician. Dr. Willem Dicke who first made the causative link between wheat and development of celiac disease was a Dutch paediatrician. Most reports on celiac disease in the literature had been in children. However, it is now well known that celiac disease in not age-specific. In fact, the majority of individuals with celiac disease are now being diagnosed as adults. Many of these are elderly individuals.
In the medical circles, celiac disease is still viewed, for most part, as a childhood disorder. This can lead to delays in the diagnosis of older individuals when they present to their family doctors even with typical symptoms. How could the 80 year-old grandfather have celiac disease, the doctor wonders? Many older individuals have other co-morbid conditions like high blood pressure, diabetes, heart problems and cancer and this can further skew the physician’s thinking about celiac disease as a possible diagnosis. Improving awareness and better education of the primary-care physicians can help change this perception. How many of those senior citizens with lactose intolerance, irritable bowel, fatigue, refractory iron deficiency anemia and chronic bloating could have celiac disease? Studiers have shown that by serological screening of individuals with these types of symptoms can significantly increase the rate of diagnosis of celiac disease.
Advocacy groups like the Canadian Celiac Association can play an important part in the awareness campaign of celiac disease in the geriatric population. Individuals with celiac disease should themselves be advocates for their family members. If one is diagnosed with celiac disease, the parents (and grandparents) should be screened, irrespective of their age. Talk to your family doctor. Celiac disease knows no age boundaries.