Symptoms and haematologic features in consecutive adult coeliac patients

Background: The aim of this study was to determine in a homogeneous adult population from Denmark, which is known to have very low incidence rates of coeliac disease, 1) the percentage of patients presenting with mild or atypical symptoms; 2) a possible change in clinical pattern over time; and 3) the delay in diagnosis and the age and sex distribution. Methods: The symptoms, delay in diagnosis, age, sex, and haematologic features of 50 consecutive adult coeliac patients, diagnosed by the same person in a uniform manner, are presented. Results: The median age was 40.5 (range, 17-82) years. The male to female sex ratio was 1:2.8. The median delay in diagnosis was 3 years. Fifty-eight per cent reported symptoms that could be attributed to coeliac disease during childhood, presenting symptoms were tiredness, 78%; borborygmus, 72%; abdominal pain, 64%; diarrhoea, 56%; weight loss, 44%; vomiting, 16%; constipation, 12%; bone pain, 12%; and dermatitis herpetiformis, 10%, Weight gain after treatment was experienced by 84%. As a group the coeliac patients had many abnormal blood analysis results, but many patients had several test results inside the normal range. Only 22% had anaemia. Liver involvement was not an uncommon feature (19% had increased transaminase levels. Low values were registered in s-iron (32%), p-folate (49%), e-folate (35%), p-vitamin B-12(11%), p-coagulation factors (II, VII, X) (32%), s-protein (21%), s-albumin (26%), s-calcium (43%), p-magnesium (13%), and s-zinc (31%). High/low IgG levels were 3%/8%; high, IgA 21%; high/low IgM, 65%,14%: and high IgE, 71%. The gliadin antibody test was the best screening test (81% positive). No changes in clinical pattern were demonstrated during the period. Conclusion: The percentage of patients presenting with anaemia (22%) and other haematologic signs of malabsorption was one of the lowest reported ever. This emphasizes the highly variable and subtle clinical expression of adult coeliac disease.