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CHICAGO—Celiac disease—the gluten-induced illness that can be seen alongside rheumatic diseases—has been seen much more commonly over the past 20 years than it was previously, but the illness can come with questions that are not always straightforward, an expert said at the ACR’s State-of-the-Art Clinical Symposium.
The disease, in which the small intestine becomes inflamed in genetically predisposed people and resolves when they stop eating gluten, used to be thought of as a very rare disorder typically seen in infancy and almost unheard of in North America, said Joseph Murray, MD, professor of gastroenterology at the Mayo Clinic.
According to a study based on data from the U.S. National Health and Nutrition Examination Survey, about 1.8 million people in the U.S. have celiac disease, although most are undiagnosed and are not on a gluten-free diet, he said. A similar number of people, interestingly, are on a gluten-free diet, but do not have celiac disease.
Dr. Murray
“The irony is, those who have celiac disease are not diagnosed, most of them, even though they would probably benefit from being on a gluten-free diet; whereas, those who are on a gluten-free diet without the diagnosis—it’s uncertain that they even need or benefit from the diet,” Dr. Murray said.
About a quarter of cases present as classic malabsorptive syndrome, with such symptoms as diarrhea, steatorrhea, weight loss and other problems. About half present as mono-symptomatic, with anemia, diarrhea, lactose intolerance or some other symptom. Another quarter of the patients present with a non-gastrointestinal problem, such as infertility, bone disease, neurological disease, shortness of stature or brittle diabetes.