<<Disclaimer: Verify this information before applying it to your situation.>> .............................................. : : : 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.