TOPLINE:

Alarm symptoms at the diagnosis of celiac disease, such as anemia and weight loss, did not lead to worse long-term outcomes after patients followed a gluten-free diet (GFD) for a median of 9.7 years; however, patients with these symptoms had a higher prevalence of osteopenia or osteoporosis than those without them.

METHODOLOGY:

• The prevalence and health implications of alarm symptoms at the diagnosis of celiac disease are not well documented, except for anemia, which is found in up to 85% of untreated patients and indicates severe disease.
• Researchers conducted a mixed-methods cohort study to examine the prevalence and effect of alarm symptoms at diagnosis and their association with patient outcomes during long-term adherence to a GFD.
• They included 814 adult patients (median age, about 44 years) with biopsy-proven celiac disease who were recruited in Finland between 2006 and 2010 through various channels.
• Alarm symptoms included anemia, unintentional weight loss, dysphagia, recurrent vomiting, melena, and rectal bleeding.
• Participants provided data through interviews and validated questionnaires assessing gastrointestinal symptoms and quality of life. Blood samples were drawn for serologic testing for celiac disease, and pathology reports were used to obtain data on small-bowel mucosal damage at diagnosis and after one year on a GFD. The median follow-up time on a GFD was 9.7 years.

TAKEAWAY:

• One or more alarm symptoms, most commonly anemia and weight loss, were present in 364 patients (45%) and absent in 450 patients (55%) at the diagnosis of celiac disease. Patients who presented with alarm symptoms were more often women and exhibited a higher prevalence of severe symptoms and advanced histological damage.
• The follow-up data showed that patients with alarm symptoms at diagnosis vs those without were on a gluten-free diet for a longer duration and had fewer persistent symptoms but a higher prevalence of osteopenia or osteoporosis (14.8% vs 8.9%; P = .008).
• The follow-up data found no significant between-group differences in health-related quality of life, adherence to a GFD, serology results, degree of mucosal damage or prevalence of fractures, malignancies, or comorbidities.
• A subgroup analysis found that patients who presented with anemia were more likely to be women, had a higher prevalence of gastrointestinal symptoms, and had symptoms for a longer duration before diagnosis, and had more advanced histological lesions than those without anemia. They reported a higher prevalence of osteoporosis or osteopenia at follow-up.
• The subgroup analysis also found that patients who presented with weight loss were less often free of other symptoms and had a higher prevalence of severe symptoms and advanced lesions compared to those without weight loss.

IN PRACTICE:

The study findings indicate “that alarm symptoms at the time of CeD [celiac disease] diagnosis might not always necessitate further investigations, at least in younger patients; however, the importance of careful clinical judgement and individualized follow-up remains crucial, especially for older adults and those with atypical presentations, particularly as we are moving toward less invasive methods for diagnosing CeD,” the authors wrote.

SOURCE:

This study, led by Eneli Katunin, Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University in Tampere, Finland, was published online in the European Journal of Gastroenterology & Hepatology.

LIMITATIONS:

Medical data recording may be incomplete, and there may be potential recall bias from patient interviews. Adherence to a GFD was not assessed by a dietitian. The exclusion of patients in poor health could lead to survival bias, affecting the generalizability of the findings.

DISCLOSURES:

This study was funded by the Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital, Finnish Pediatric Foundation, Paivikki and Sakari Sohlberg Foundation, Emil Aaltonen Foundation, Academy of Finland, and Finnish Cultural Foundation. Three authors reported receiving lecture fees from the Finnish Coeliac Society outside the submitted work and serving as members of its advisory committee.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.