Antibody negative coeliac disease presenting in elderly people--an easily missed diagnosis

doi:10.1136/bmj.330.7494.775

BMJ 2005;330:775-776 (2 April), doi:10.1136/bmj.330.7494.775

Clinical review

Lesson of the week

Antibody negative coeliac disease presenting in elderly people—an easily missed diagnosis

David S Sanders, consultant gastroenterologist¹, David P Hurlstone, consultant gastroenterologist¹, Mark E McAlindon, consultant gastroenterologist¹, Marios Hadjivassiliou, consultant neurologist¹, Simon S Cross, consultant histopathologist¹, Graeme Wild, senior scientist in immunology¹, Christopher J Atkins, general practitioner²

¹ Royal Hallamshire Hospital, Sheffield S10 2JF, ² Greystones Medical Centre, Sheffield S11 7BJ

Correspondence to: D S Sanders, Room P39, P Floor, Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield S10 2JF d.s.sanders28@btopenworld.com

The first 150 words of the full text of this article appear below.

Introduction

Epidemiological studies screening cohorts of healthy volunteersin the United States of America, the United Kingdom, and otherEuropean countries have determined that the prevalence of adultcoeliac disease in the general population is in the magnitudeof 1 per 100 to 200.^1-4

The diagnosing of coeliac disease is often delayed,^3-7 perhapsowing to a failure to recognise the protean manifestations ofthis disease in both primary and secondary care.^5-9 Coeliacdisease used to be perceived as involving gastrointestinal symptomssuggestive of malabsorption, but this manner of presentationis now described as the classic (typical) form.⁴ Patients withcoeliac disease may have the silent or atypical form (no gastrointestinalsymptoms), and the condition may present insidiously—forexample, with iron deficiency anaemia, osteoporosis, cryptogenichypertransaminasaemia, or neurological symptoms.^5-10 The increasingrecognition of coeliac disease is attributed to the use of newserological assays that have a high sensitivity and specificity.⁴Antibody . . . [Full text of this article]

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