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: :
: Excerpts from _Alamo Celiac_ :
: ---------------------------- :
: Dec. 1999 Lynn Rainwater, editor :
: San Antonio CS Support Group :
: 1023 Cloverbrook :
: San Antonio, TX 78245-1604 :
:............................................:
A Study of Subclinical/Silent Celiac Disease
--------------------------------------------
a review by Lynn Rainwater
This is a review of "The clinical pattern of subclinical/silent celiac
disease: An analysis on 1026 cases", by G. Bottaro, F. Cataldo, N.
Rotolo, M. Spina, G. R. Corazza, The American Journal of
Gastroenterology, March 1999, Vol. 94, No. 3.
We are slowly building a better picture of celiac disease. Diagnosing
physicians have found there are many celiacs whose disease does not
fit the classical definition of a gluten-sensitive enteropathy
accompanied by gastrointestinal symptoms (diarrhea, weight loss,
abdominal pain, vomiting). In this Italian study, the authors focused
on patients diagnosed with subclinical or silent celiac disease. They
defined subclinical celiac disease as a gluten-sensitive enteropathy
with extraintestinal symptoms; silent celiac disease as a
gluten-sensitive enteropathy not accompanied by any symptoms, but
identified during screening.
Forty-two centers throughout Italy participated in the study, which
looked at all subclinical/silent celiac patients diagnosed by them
during the five-year period 1990-1994.
The table below gives some basic numbers for the study. The larger
number of children in the study was due to the fact that 30 of the 42
participating centers dealt with childhood celiac disease, 7 with
adult celiac disease, and 5 with both (children's centers who treated
adults in the absence of gastroenterologists interested in celiac
disease.)
Total Children Adults
----- -------- ------
Classical cases 2,443 2,036 407
Subclinical/silent cases 1,026 644 382
Subclinical/silent cases with
first-degree relatives
with celiac disease 192 101 91
Subclinical/silent cases as
% of total cases 29.6% 24.0% 48.4%
A breakdown of the subclinical/silent cases by number of symptoms
showed:
Total Children Adults
----- -------- ------
More than one symptom 365 234 131
One symptom 433 251 182
No symptoms 228 159 69
Primary symptoms that led to intestinal biopsy for the patients
diagnosed with subclinical celiac disease, with frequency (%) of each
symptom also shown, were as follows (percentages rounded up to nearest
whole number):
Total Children Adults
----- -------- ------
Iron-deficiency anemia 314 39 % 169 35 % 145 46 %
Short stature 153 19 % 145 30 % 8 3 %
Dermatitis herpetiformis 73 9 % 12 2 % 61 19 %
Anorexia 62 8 % 62 13 % 0 0 %
Epilepsy/cerebral calcifications 26 3 % 13 3 % 13 4 %
Neuropsychic complaints 25 3 % 18 4 % 7 2 %
Constipation 21 3 % 17 4 % 4 1 %
Osteoporosis 11 1 % 0 0 % 11 4 %
Other 112 14 % 48 10 % 64 20 %
Of the 228 patients diagnosed with silent celiac disease (all but
three identified through blood screening), 91 (39.9%) were
first-degree relatives of celiac patients, 55 (24.1%) had type 1
diabetes, 7 (3.1%) had Down's syndrome, and 5 (2.2%) had IgA
deficiency.
The most common associated diseases for all the study patients, both
those with subclinical and those with silent celiac disease, with
frequency (%) of each symptom also shown, were:
Total
Children
Adults
Total Children Adults
----- -------- ------
Type 1 diabetes 76 7.4 % 49 7.6 % 27 7.1 %
Atopy (allergy) 32 3.1 % 22 3.4 % 10 2.6 %
Down's syndrome 19 1.9 % 18 2.8 % 1 0.3 %
IgA deficiency 15 1.5 % 11 1.7 % 4 1.0 %
After diagnosis, a strict gluten-free diet was followed by all
subclinical and silent cases. The patients with subclinical celiac
disease quickly improved, with all symptoms disappearing within 12-15
months. Only 50 of the 228 patients with silent celiac disease noted
an improvement in their health.
The centers participating in this study, along with the authors, are
to be commended for establishing a knowledge base for us in the area
of subclinical and silent celiac disease.
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