Is Undiagnosed Coeliac Disease Important?

Coeliac disease sometimes is diagnosed by chance (i.e., at Gastroscopy or on screening blood tests) in patients without typical symptoms.

Thus, we need to know whether undiscovered or asymptomatic Coeliac disease leads to an excess mortality or complications.

The Mayo Clinic researchers analyzed stored blood samples, obtained between 1995 and 2001, from nearly 17,000 adults without known Coeliac disease; 129 people (0.8%) had undiagnosed Coeliac disease, based on positive blood test results ( Tissue transglutaminase and endomysial antibodies).

During average follow-up of 10 years, all-cause mortality and cancer-specific mortality were similar in the groups, as was the prevalence of various gastrointestinal symptoms (e.g., diarrhea, weight loss, abdominal pain). From a long list of diseases, only osteoporosis and hypothyroidism (under active thoid function) were more prevalent among case patients than among controls.

During the 10-year follow-up, 20 of the 129 patients with undiagnosed Coeliac disease (but no controls) ultimately received clinical diagnoses of Coeliac disease — most often during evaluation of iron deficiency.

Comment: In this study, middle-aged and older adults with undiagnosed Coeliac disease were not at obvious risk for premature death or major morbidity during a decade of observation. Thus, the value of a gluten-free diet among older adults with asymptomatic Coeliac disease seems questionable.

November 2010