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Celiac Disease Presenting in a Community-Based Gastroenterology Practice: Obesity and Bone Disease Are Common

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Abstract

Background

The description of the clinical presentation of celiac disease (CeD) has usually come from studies at referral centers. Data about CeD presentation in the community are sparse.

Aims

We aim to describe the clinical presentation of patients with biopsy-proven CeD at a community-based adult gastroenterology practice and compare it to a referral center.

Methods

We performed a retrospective study of two cohorts of patients diagnosed with CeD between 2000–2007 (n = 117) and 2013–2016 (n = 91) in a community practice, and a third cohort (n = 188) diagnosed between 2000 and 2007 in a tertiary referral center. The clinical presentation, body mass index, tissue-transglutaminase levels, DEXA scan, vitamin D levels, and vaccine recommendations were assessed.

Results

Celiac disease presentation changed over time in the two community cohorts. Recently, fewer patients presented with diarrhea and anemia, but constipation and neurologic symptoms were more common. The most recent cohort had a higher proportion of patients who were overweight or obese than the first cohort. However, the body mass index in both community cohorts was higher than in the tertiary referral center. The frequency of osteopenia and osteoporosis was high in both community cohorts. The tertiary referral center patients were younger, presented with a higher proportion of diarrhea and a lower body mass index.

Conclusions

The clinical presentation of CeD differs between the community setting and a tertiary referral center. Patients with CeD presenting to the community setting tended to be older, overweight, and to have a high proportion of mineral bone disease.

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Funding

There was no grant support or other assistance.

Author information

Authors and Affiliations

  1. Internal Medicine Department, Jackson Memorial Hospital, University of Miami, Miami, FL, 33136, USA

    Giovanni A. Roldan

  2. Celiac Center at Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA

    Giovanni A. Roldan & Daniel Leffler

  3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA

    Sehrish Jamot

  4. Connecticut GI, PC, Farmington, CT, 06032, USA

    Krzysztof Kopec

  5. Division of Gastroenterology, Department of Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, 02904, USA

    Amber Charoen & Samir A. Shah

  6. Division of Medical Education, Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA

    Edward R. Feller

  7. Gastroenterology Associates, Inc., 44 West River Street, Providence, RI, 02904, USA

    Samir A. Shah

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  1. Giovanni A. Roldan
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Contributions

All authors contributed substantially to the manuscript and approved the final manuscript. The study was conceived by SAS, with input from ERF. KK and SAS wrote the protocol for IRB approval, and KK did the initial chart reviews and collection of data for the original community cohort. SJ performed the update and gathered the data for the second cohort. SAS did a second chart review of the second cohort for presenting symptoms. DL, GAR, and AC were involved with the data from the tertiary referral center for comparison and provided critical input for the poster and paper. The bulk of the manuscript was written by GAR, SJ, AC, and SAS with critical input from all the authors. Each author read and approved the final submitted manuscript.

Corresponding author

Correspondence to Samir A. Shah.

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Roldan, G.A., Jamot, S., Kopec, K. et al. Celiac Disease Presenting in a Community-Based Gastroenterology Practice: Obesity and Bone Disease Are Common. Dig Dis Sci 68, 860–866 (2023). https://doi.org/10.1007/s10620-022-07521-9

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  • DOI: https://doi.org/10.1007/s10620-022-07521-9

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