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Celiac Disease

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Geriatric Gastroenterology

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Abstract

A long-standing misconception that celiac disease (CD), also known as gluten enteropathy or nontropical sprue, is exclusively a pediatric problem dissuades clinicians from considering the condition as a clinical possibility in older adults. A second erroneous notion is that CD is frequent mostly among people of Northern European descent. Further, the older generation of clinicians expects signs and symptoms of overt malabsorption in the diagnostic consideration. Indeed, CD has no classic symptoms, can manifest at any age, and affects any ethnic group. The presentation of CD with atypical manifestations is more common than that with typical symptoms. CD is a multi-system disease. As a result of increased awareness, the easy availability of serum tests, and the feasibility of obtaining endoscopic mucosal biopsies, the disease is being recognized often. It is not clear whether the incidence has increased, but the prevalence of CD appears to be growing globally even in Afro-Asian countries, once thought to be free from the disease.

Serum antibody tests establish the diagnosis; small intestinal mucosal changes show varying degrees of small bowel villous atrophy and inflammation; and clinical response to a gluten-free diet is helpful. Regarding pathogenesis, the ingestion of gluten, a family of storage proteins that are naturally found in particular cereal grains wheat, barley, and rye, causes both innate and adaptive immune responses. The autoimmune response results in an increase of gut permeability inflammation, crypt hyperplasia, and villus atrophy. A gluten-free diet is the principle of management in addition to appropriate correction of nutritional deficiencies.

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Authors and Affiliations

  1. Department of Medicine, Robert Wood Johnson School of Medicine, Rutgers University, New Brunswick, NJ, USA

    C. S. Pitchumoni

  2. Department of Medicine, New York Medical College, Valhalla, NY, USA

    C. S. Pitchumoni

  3. Division of Gastroenterology, Hepatology and Clinical Nutrition, Saint Peters University Hospital, New Brunswick, NJ, USA

    C. S. Pitchumoni

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  1. Department of Medicine, Robert Wood Johnson School of Medicine, Rutgers University, New Brunswick, NJ, USA

    C. S. Pitchumoni

  2. Department of Medicine, Division of Geriatrics, Montefiore Medical Center, Wakefield Campus, Bronx, NY, USA

    T.S. Dharmarajan

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Pitchumoni, C.S. (2021). Celiac Disease. In: Pitchumoni, C.S., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-030-30192-7_69

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