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Coeliac disease in the older person

Published online by Cambridge University Press:  12 October 2012

Stephanie M Robinson ,
Ramona McLoughlin  and
Shaun T O'Keeffe
Stephanie M Robinson
Affiliation:
Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland
Ramona McLoughlin
Affiliation:
Department of Gastroenterology, Galway University Hospitals, Galway, Ireland
Shaun T O'Keeffe*
Affiliation:
Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland
*
Address for correspondence: Dr S. O'Keeffe, Unit 4, Merlin Park University Hospital, Galway, Ireland. Email: sokanc@iolfree.ie
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Summary

Coeliac disease (CD) results from immunologically mediated inflammation of the small intestinal mucosa precipitated by ingestion of gluten in wheat and other cereals in genetically susceptible people. There is a broad spectrum of clinical and histological features associated with gluten sensitivity. Overt clinical malabsorption is uncommon, and clinical symptoms are often non-specific. This is particularly true of older people and the diagnosis of CD may be delayed or missed as a result. The incidence of metabolic bone disease, neurological symptoms and nutritional deficiencies are high in older people with CD and respond well to treatment. Sensitive and specific serological tests are now available and these have improved ease of detection of CD in patients without classical symptoms. Hence, a high index of suspicion is warranted in older people with potential symptoms of CD.

Keywords

coeliac diseaseolder peoplegluten sensitivitymalabsorptionmetabolic bone diseaseanaemia
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 23 , Issue 1 , February 2013 , pp. 32 - 42
Copyright
Copyright © Cambridge University Press 2012

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References

1Paulley, JW. Observation on the aetiology of idiopathic steatorrhoea; jejunal and lymph-node biopsies. BMJ 1954; 2: 1318–21.CrossRefGoogle ScholarPubMed
2Rostom, A, Murray, JA, Kagnoff, MF. American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease. Gastroenterology 2006; 131: 1981–2002.CrossRefGoogle ScholarPubMed
3Husby, S, Koletzko, S, Korponay-Szabo, IR, Mearin, ML, Phillips, A, Shamir, Ret al.European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Paed Gastro Nutrition 2012; 54: 136–60.CrossRefGoogle Scholar
4National Institute for Health and Clinical Excellence. Recognition and assessment of coeliac disease. CG86. London: National Institute for Health and Clinical Excellence, 2009.Google Scholar
5Ciclitira, PJ, Dewar, DH, McLaughlin, SD, Sanders, DS. The management of adults with coeliac disease. British Society of Gastoenterology, 2010.Google Scholar
6Holmes, G, Catassi, C, Fasano, A. Celiac disease, 2nd edn.Abingdon: Health, 2009. 128 pp.Google Scholar
7Maki, M, Collin, P. Coeliac disease. Lancet 1997; 349: 1755–59.CrossRefGoogle ScholarPubMed
8Marsh, MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology 1992; 102: 330–54.CrossRefGoogle Scholar
9O'Mahony, S, Vestey, JP, Ferguson, A. Similarities in intestinal humoral immunity in dermatitis herpetiformis without enteropathy and in coeliac disease. Lancet 1990; 335: 1487–90.CrossRefGoogle ScholarPubMed
10Walker, MM, Murray, JA, Ronkainen, J, Aro, P, Storskrubb, T, D'Amato, M, Lahr, B, Talley, NJ, Agreus, L. Detection of celiac disease and lymphocytic enteropathy by parallel serology and histopathology in a population-based study. Gastroenterology 2010; 139: 112–19.CrossRefGoogle ScholarPubMed
11van Heel, DA, Hunt, K, Greco, L, Wijmenga, C. Genetics in coeliac disease. Best practice and research. Clin Gastroenterology 2005; 19: 323–39.Google Scholar
12Murray, JA, Moore, SB, Van Dyke, CT, Lahr, BD, Dierkhising, RA, Zinsmeister, AR, Melton, LJ 3rd, Kroning, CM, El-Yousseff, M, Czaja, AJ. HLA DQ gene dosage and risk and severity of celiac disease. Clin Gastro Hepatol 2007; 5: 1406–12.CrossRefGoogle ScholarPubMed
13Srinivasan, U, Leonard, N, Jones, E, Kasarda, DD, Weir, DG, O'Farrelly, C, Feighery, C. Absence of oats toxicity in adult coeliac disease. BMJ 1996; 313: 1300–1.CrossRefGoogle ScholarPubMed
14Janatuinen, EK, Pikkarainen, PH, Kemppainen, TA, Kosma, VM, Järvinen, RM, Uusitupa, MI, Julkunen, RJ. A comparison of diets with and without oats in adults with celiac disease. N Engl J Med 1995; 333: 1033–37.CrossRefGoogle ScholarPubMed
15Storsrud, S, Olsson, M, Arvidsson Lenner, R, Nilsson, LA, Nilsson, O, Kilander, A. Adult coeliac patients do tolerate large amounts of oats. Eur J Clin Nutr 2003; 57: 163–69.CrossRefGoogle ScholarPubMed
16Arentz-Hansen, H, Fleckenstein, B, Molberg, Ø, Scott, H, Koning, F, Jung, G, Roepstorff, P, Lundin, KE, Sollid, LM. The molecular basis for oat intolerance in patients with celiac disease. PLoS Med 2004; 1: e1.CrossRefGoogle ScholarPubMed
17Ferguson, A, McClure, JP, Townley, RR. Intraepithelial lymphocyte counts in small intestinal biopsies from children with diarrhoea. Acta Paed Scandin 1976; 65: 541–46.CrossRefGoogle ScholarPubMed
18Talley, NJ, Valdovinos, M, Petterson, TM, Carpenter, HA, Melton, LJ 3rd. Epidemiology of celiac sprue: a community-based study. Am J Gastro 1994; 89: 843–46.Google ScholarPubMed
19Fasano, A, Berti, I, Gerarduzzi, T, Not, T, Colletti, RB, Drago, S, Elitsur, Y, Green, PH, Guandalini, S, Hill, ID, Pietzak, M, Ventura, A, Thorpe, M, Kryszak, D, Fornaroli, F, Wasserman, SS, Murray, JA, Horvath, K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Int Med 2003; 163: 286–92.CrossRefGoogle ScholarPubMed
20Bingley, PJ, Williams, AJ, Norcross, AJ, Unsworth, DJ, Lock, RJ, Ness, AR, Jones, RW; Avon Longitudinal Study of Parents and Children Study Team. Undiagnosed coeliac disease at age seven: population based prospective birth cohort study. BMJ 2004; 328: 322–23.CrossRefGoogle Scholar
21Mäki, M, Mustalahti, K, Kokkonen, J, Kulmala, P, Haapalahti, M, Karttunen, T, Ilonen, J, Laurila, K, Dahlbom, I, Hansson, T, Höpfl, P, Knip, M. Prevalence of celiac disease among children in Finland. N Engl J Med 2003; 348: 2517–24.CrossRefGoogle ScholarPubMed
22Ravikumara, M, Nootigattu, VK, Sandhu, BK. Ninety percent of celiac disease is being missed. J Paed Gastro Nutrition 2007; 45: 497–99.CrossRefGoogle ScholarPubMed
23Lohi, S, Mustalahti, K, Kaukinen, K, Laurila, K, Collin, P, Rissanen, H, Lohi, O, Bravi, E, Gasparin, M, Reunanen, A, Mäki, M. Increasing prevalence of coeliac disease over time. Aliment Pharmacol Therap 2007; 26: 1217–25.CrossRefGoogle ScholarPubMed
24Kondrashova, A, Mustalahti, K, Kaukinen, K, Viskari, H, Volodicheva, V, Haapala, AM, Ilonen, J, Knip, M, Mäki, M, Hyöty, H; Epivir Study Group. Lower economic status and inferior hygienic environment may protect against celiac disease. Ann Medicine 2008; 40: 223–31.CrossRefGoogle ScholarPubMed
25Loft, DE, Nwokolo, CU, Ciclitira, PJ. The diagnosis of gluten sensitivity and coeliac disease – the two are not mutually inclusive. Euro J Gastro Hepatol 1998; 10: 911–13.CrossRefGoogle Scholar
26Gumaa, SN, McNicholl, B, Egan-Mitchell, B, Connolly, K, Loftus, BG. Coeliac disease in Galway, Ireland 1971–1990. Ir Med J 1997; 90: 60–1.Google ScholarPubMed
27Murray, JA, Van Dyke, C, Plevak, MF, Dierkhising, RA, Zinsmeister, AR, Melton, LJ 3rd. Trends in the identification and clinical features of celiac disease in a North American community, 1950–2001. Clin Gastro Hepatol 2003; 1: 19–27.CrossRefGoogle Scholar
28Vilppula, A, Kaukinen, K, Luostarinen, L, Krekelä, I, Patrikainen, H, Valve, R, Mäki, M, Collin, P. Increasing prevalence and high incidence of celiac disease in elderly people: a population-based study. BMC Gastro 2009; 9: 49.CrossRefGoogle ScholarPubMed
29Cooke, WT, Holmes, GKT. Coeliac Disease. Edinburgh: Churchill Livingstone; 1984. 281 pp.Google Scholar
30Midhagen, G, Jarnerot, G, Kraaz, W. Adult coeliac disease within a defined geographic area in Sweden. A study of prevalence and associated diseases. Scand J Gastrol 1988; 23: 1000–4.CrossRefGoogle ScholarPubMed
31Kirby, J, Fielding, JF. Very adult coeliac disease! The need for jejunal biopsy in the middle aged and elderly. Ir Med J 1984; 77: 35–36.Google ScholarPubMed
32Walters, JR. Bone mineral density in coeliac disease. Gut 1994; 35: 150–51.CrossRefGoogle ScholarPubMed
33Caraceni, MP, Molteni, N, Bardella, MT, Ortolani, S, Nogara, A, Bianchi, PA. Bone and mineral metabolism in adult celiac disease. Am J Gastrol 1988; 83: 274–77.Google ScholarPubMed
34Tai, V, Crowe, M, O'Keeffe, S. Celiac disease in older people. J Am Ger Soc 2000; 48: 1690–96.CrossRefGoogle ScholarPubMed
35Duggan, JM. Recent developments in our understanding of adult coeliac disease. Med J Aust 1997; 166: 312–15.CrossRefGoogle ScholarPubMed
36Sollid, LM, Lie, BA. Celiac disease genetics: current concepts and practical applications. Clin Gastro Hepatol 2005; 3: 843–51.CrossRefGoogle ScholarPubMed
37Dickey, W, Kearney, N. Overweight in celiac disease: prevalence, clinical characteristics, and effect of a gluten-free diet. Am J Gastrol 2006; 101: 2356–59.CrossRefGoogle ScholarPubMed
38Ferguson, MM, Wray, D, Carmichael, HA, Russell, RI, Lee, FD. Coeliac disease associated with recurrent aphthae. Gut 1980; 21: 223–26.CrossRefGoogle ScholarPubMed
39Corazza, GR, Di Sario, A, Cecchetti, L, Tarozzi, C, Corrao, G, Bernardi, M, Gasbarrini, G. Bone mass and metabolism in patients with celiac disease. Gastroenterology 1995; 109: 122–28.CrossRefGoogle ScholarPubMed
40Meyer, D, Stavropolous, S, Diamond, B, Shane, E, Green, PH. Osteoporosis in a north American adult population with celiac disease. Am J Gastrol 2001; 96: 112–19.Google Scholar
41Jafri, MR, Nordstrom, CW, Murray, JA, Van Dyke, CT, Dierkhising, RA, Zinsmeister, AR, Melton, LJ 3rd. Long-term fracture risk in patients with celiac disease: a population-based study in Olmsted County, Minnesota. Dig Dis Sci 2008; 53: 964–71.CrossRefGoogle ScholarPubMed
42Stenson, WF, Newberry, R, Lorenz, R, Baldus, C, Civitelli, R. Increased prevalence of celiac disease and need for routine screening among patients with osteoporosis. Arch Int Med 2005; 165: 393–99.CrossRefGoogle ScholarPubMed
43Cellier, C, Patey, N, Mauvieux, L, Jabri, B, Delabesse, E, Cervoni, JP, Burtin, ML, Guy-Grand, D, Bouhnik, Y, Modigliani, R, Barbier, JP, Macintyre, E, Brousse, N, Cerf-Bensussan, N. Abnormal intestinal intraepithelial lymphocytes in refractory sprue. Gastroenterology 1998; 114: 471–81.CrossRefGoogle ScholarPubMed
44Hallert, C, Tobiasson, P, Walan, A. Serum folate determinations in tracing adult coeliacs. Scand J Gastrol 1981; 16: 263–67.CrossRefGoogle ScholarPubMed
45Fine, KD. The prevalence of occult gastrointestinal bleeding in celiac sprue. N Engl J Med 1996; 334: 1163–67.CrossRefGoogle ScholarPubMed
46Paulley, JW, Fairweather, FA, Leeming, A. Post-gastrectomy steatorrhoea and patchy jejunal atrophy. Lancet 1957; 272: 406–7.CrossRefGoogle ScholarPubMed
47Bushara, KO, Goebel, SU, Shill, H, Goldfarb, LG, Hallett, M. Gluten sensitivity in sporadic and hereditary cerebellar ataxia. Ann Neurol 2001; 49: 540–43.CrossRefGoogle ScholarPubMed
48Bushara, KO, Nance, M, Gomez, CM. Antigliadin antibodies in Huntington's disease. Neurology 2004; 62: 132–33.CrossRefGoogle ScholarPubMed
49Hadjivassiliou, M, Gibson, A, Davies-Jones, GA, Lobo, AJ, Stephenson, TJ, Milford-Ward, A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet 1996; 347: 369–71.CrossRefGoogle ScholarPubMed
50Hadjivassiliou, M, Grünewald, RA, Chattopadhyay, AK, Davies-Jones, GA, Gibson, A, Jarratt, JA, Kandler, RH, Lobo, A, Powell, T, Smith, CM. Clinical, radiological, neurophysiological, and neuropathological characteristics of gluten ataxia. Lancet 1998; 352: 1582–85.CrossRefGoogle ScholarPubMed
51Cooke, WT, Smith, WT. Neurological disorders associated with adult coeliac disease. Brain 1966; 89: 683–722.CrossRefGoogle ScholarPubMed
52Mauro, A, Orsi, L, Mortara, P, Costa, P, Schiffer, D. Cerebellar syndrome in adult celiac disease with vitamin E deficiency. Acta Neurol Scand 1991; 84: 167–70.CrossRefGoogle ScholarPubMed
53Hadjivassiliou, M, Boscolo, S, Davies-Jones, GA, Grünewald, RA, Not, T, Sanders, DS, Simpson, JE, Tongiorgi, E, Williamson, CA, Woodroofe, NM. The humoral response in the pathogenesis of gluten ataxia. Neurology 2002; 58: 1221–26.CrossRefGoogle ScholarPubMed
54Shams, PN, Waldman, A, Dogan, A, MacKenzie, JM, Plant, GT. Ataxia in the setting of complicated enteropathy: double jeopardy. J Neurol Neurosurg Psych 2002; 72: 527–29.Google ScholarPubMed
55Cicarelli, G, Della Rocca, G, Amboni, M, Ciacci, C, Mazzacca, G, Filla, A, Barrone, P. Clinical and neurological abnormalities in adult celiac disease. Neurol Sci 2003; 24: 311–17.CrossRefGoogle ScholarPubMed
56Chin, RL, Sander, HW, Brannagan, TH, Green, PH, Hays, AP, Alaedini, A, Latov, N. Celiac neuropathy. Neurology 2003; 60: 1581–85.CrossRefGoogle ScholarPubMed
57Banerji, NK, Hurwitz, LJ. Neurological manifestations in adult steatorrhoea (probable gluten enteropathy). J Neurol Sci 1971; 14: 125–41.CrossRefGoogle ScholarPubMed
58Kaplan, JG, Pack, D, Horoupian, D, DeSouza, T, Brin, M, Schaumburg, H. Distal axonopathy associated with chronic gluten enteropathy: a treatable disorder. Neurology 1988; 38: 642–45.CrossRefGoogle ScholarPubMed
59Usai, P, Usai Satta, P, Lai, M, Corda, MG, Piras, E, Calcara, C, Boy, MF, Morelli, A, Balestrieri, A, Bassotti, G. Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease. Euro J Clin Invest 1997; 27: 1009–15.CrossRefGoogle ScholarPubMed
60Luostarinen, L, Himanen, SL, Luostarinen, M, Collin, P, Pirttila, T. Neuromuscular and sensory disturbances in patients with well treated coeliac disease. J Neurol Neurosurg Psych 2003; 74: 490–94.CrossRefGoogle ScholarPubMed
61Collin, P, Pirttila, T, Nurmikko, T, Somer, H, Erila, T, Keyrilainen, O. Celiac disease, brain atrophy, and dementia. Neurology 1991; 41: 372–75.CrossRefGoogle ScholarPubMed
62Hu, WT, Murray, JA, Greenaway, MC, Parisi, JE, Josephs, KA. Cognitive impairment and celiac disease. Arch Neurol 2006; 63: 1440–46.CrossRefGoogle ScholarPubMed
63Lurie, Y, Landau, DA, Pfeffer, J, Oren, R. Celiac disease diagnosed in the elderly. J Clin Gastrol 2008; 42: 59–61.CrossRefGoogle ScholarPubMed
64Hardoff, D, Sharf, B, Berger, A. Myopathy as a presentation of coeliac disease. Devel Med Child Neurol 1980; 22: 781–83.CrossRefGoogle ScholarPubMed
65Gobbi, G, Ambrosetto, P, Zaniboni, MG, Lambertini, A, Ambrosioni, G, Tassinari, CA. Celiac disease, posterior cerebral calcifications and epilepsy. Brain Dev 1992; 14: 23–29.CrossRefGoogle ScholarPubMed
66Christensen, OB, Hindsen, M, Svensson, A. Natural history of dermatitis herpetiformis in southern Sweden. Dermatologica 1986; 173: 271–77.CrossRefGoogle ScholarPubMed
67Hakanen, M, Luotola, K, Salmi, J, Laippala, P, Kaukinen, K, Collin, P. Clinical and subclinical autoimmune thyroid disease in adult celiac disease. Dig Dis Sci 2001; 46: 2631–35.CrossRefGoogle ScholarPubMed
68Verdu, EF, Armstrong, D, Murray, JA. Between celiac disease and irritable bowel syndrome: the ‘no man's land’ of gluten sensitivity. Am J Gastrol 2009; 104: 1587–94.CrossRefGoogle ScholarPubMed
69Sjoberg, K, Alm, R, Ivarsson, SA, Lindstrom, C, Eriksson, S. Prevalence and clinical significance of gliadin antibodies in healthy children and adults. Scand J Gastrol 1994; 29: 248–54.CrossRefGoogle ScholarPubMed
70Grodzinsky, E, Franzen, L, Hed, J, Strom, M. High prevalence of celiac disease in healthy adults revealed by antigliadin antibodies. Ann Allergy 1992; 69: 66–70.Google ScholarPubMed
71Salmi, TT, Collin, P, Korponay-Szabó, IR, Laurila, K, Partanen, J, Huhtala, H, Király, R, Lorand, L, Reunala, T, Mäki, M, Kaukinen, K. Endomysial antibody-negative coeliac disease: clinical characteristics and intestinal autoantibody deposits. Gut 2006; 55: 1746–53.CrossRefGoogle ScholarPubMed
72Holbrook, I. The British Society of Gastroenterology guidelines for the investigation of chronic diarrhoea, 2nd edn. Ann Clin Bioch 2005; 42: 170–74.CrossRefGoogle ScholarPubMed
73Pais, WP, Duerksen, DR, Pettigrew, NM, Bernstein, CN. How many duodenal biopsy specimens are required to make a diagnosis of celiac disease? Gastro Endos 2008; 67: 1082–87.CrossRefGoogle ScholarPubMed
74Bardella, MT, Minoli, G, Radaelli, F, Quatrini, M, Bianchi, PA, Conte, D. Reevaluation of duodenal endoscopic markers in the diagnosis of celiac disease. Gastro Endos 2000; 51: 714–16.CrossRefGoogle ScholarPubMed
75Tursi, A, Brandimarte, G. The symptomatic and histologic response to a gluten-free diet in patients with borderline enteropathy. J Clin Gastrol 2003; 36: 13–17.CrossRefGoogle ScholarPubMed
76Vilppula, A, Kaukinen, K, Luostarinen, L, Krekelä, I, Patrikainen, H, Valve, R, Luostarinen, M, Laurila, K, Mäki, M, Collin, P. Clinical benefit of gluten-free diet in screen-detected older celiac disease patients. BMC Gastro 2011; 11: 136.CrossRefGoogle ScholarPubMed
77Nachman, F, Sugai, E, Vázquez, H, González, A, Andrenacci, P, Niveloni, S, Mazure, R, Smecuol, E, Moreno, ML, Hwang, HJ, Sánchez, MI, Mauriño, E, Bai, JC. Serological tests for celiac disease as indicators of long-term compliance with the gluten-free diet. Euro J Gastrol Hepatol 2011; 23: 473–80.Google ScholarPubMed
78Tursi, A, Brandimarte, G, Giorgetti, G. High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal. Am J Gastrol 2003; 98: 839–43.CrossRefGoogle ScholarPubMed
79Rubio-Tapia, A, Kelly, DG, Lahr, BD, Dogan, A, Wu, TT, Murray, JA. Clinical staging and survival in refractory celiac disease: a single center experience. Gastroenterology 2009; 136: 99–107.CrossRefGoogle ScholarPubMed
80Goerres, MS, Meijer, JW, Wahab, PJ, Kerckhaert, JA, Groenen, PJ, Van Krieken, JH, Mulder, CJ. Azathioprine and prednisone combination therapy in refractory coeliac disease. Alim Pharm Therap 2003; 18: 487–94.CrossRefGoogle ScholarPubMed
81Verbeek, WH, Schreurs, MW, Visser, OJ, von Blomberg, BM, Al-Toma, A, Mulder, CJ. Novel approaches in the management of refractory celiac disease. Exp Rev Clin Immunol 2008; 4: 205–19.CrossRefGoogle ScholarPubMed
82Malamut, G, Afchain, P, Verkarre, V, Lecomte, T, Amiot, A, Damotte, D, Bouhnik, Y, Colombel, JF, Delchier, JC, Allez, M, Cosnes, J, Lavergne-Slove, A, Meresse, B, Trinquart, L, Macintyre, E, Radford-Weiss, I, Hermine, O, Brousse, N, Cerf-Bensussan, N, Cellier, C. Presentation and long-term follow-up of refractory celiac disease: comparison of type I with type II. Gastroenterology 2009; 136: 81–90.CrossRefGoogle ScholarPubMed
83Corrao, G, Corazza, GR, Bagnardi, V, Brusco, G, Ciacci, C, Cottone, M, Sategna Guidetti, C, Usai, P, Cesari, P, Pelli, MA, Loperfido, S, Volta, U, Calabró, A, Certo, M; Club del Tenue Study Group. Mortality in patients with coeliac disease and their relatives: a cohort study. Lancet 2001; 358: 356–61.CrossRefGoogle ScholarPubMed
84West, J, Logan, RF, Smith, CJ, Hubbard, RB, Card, TR. Malignancy and mortality in people with coeliac disease: population based cohort study. BMJ 2004; 329: 716–19.CrossRefGoogle ScholarPubMed
85Rubio-Tapia, A, Kyle, RA, Kaplan, EL, Johnson, DR, Page, W, Erdtmann, F, Brantner, TL, Kim, WR, Phelps, TK, Lahr, BD, Zinsmeister, AR, Melton, LJ 3rd, Murray, JA. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology 2009; 137: 88–93.CrossRefGoogle ScholarPubMed
86Metzger, MH, Heier, M, Mäki, M, Bravi, E, Schneider, A, Löwel, H, Illig, T, Schuppan, D, Wichmann, HE. Mortality excess in individuals with elevated IgA anti-transglutaminase antibodies: the KORA/MONICA Augsburg cohort study 1989–1998. Eur J Epidem 2006; 21: 359–65.CrossRefGoogle ScholarPubMed
87Lohi, S, Maki, M, Rissanen, H, Knekt, P, Reunanen, A, Kaukinen, K. Prognosis of unrecognized coeliac disease as regards mortality: a population-based cohort study. Ann Int Med 2009; 41: 508–15.CrossRefGoogle ScholarPubMed
88Godfrey, JD, Brantner, TL, Brinjikji, W, Christensen, KN, Brogan, DL, Van Dyke, CT, Lahr, BD, Larson, JJ, Rubio-Tapia, A, Melton, LJ 3rd, Zinsmeister, AR, Kyle, RA, Murray, JA. Morbidity and mortality among older individuals with undiagnosed celiac disease. Gastroenterology 2010; 139: 763–69.CrossRefGoogle ScholarPubMed
89Holmes, GK, Prior, P, Lane, MR, Pope, D, Allan, RN. Malignancy in coeliac disease – effect of a gluten-free diet. Gut 1989; 30: 333–38.CrossRefGoogle ScholarPubMed
90Rampertab, SD, Forde, KA, Green, PH. Small bowel neoplasia in coeliac disease. Gut 2003; 52: 1211–14.CrossRefGoogle ScholarPubMed
91Green, PH, Fleischauer, AT, Bhagat, G, Goyal, R, Jabri, B, Neugut, AI. Risk of malignancy in patients with celiac disease. Am J Med 2003; 115: 191–95.CrossRefGoogle ScholarPubMed
92Smedby, KE, Akerman, M, Hildebrand, H, Glimelius, B, Ekbom, A, Askling, J. Malignant lymphomas in coeliac disease: evidence of increased risks for lymphoma types other than enteropathy-type T cell lymphoma. Gut 2005; 54: 54–59.CrossRefGoogle ScholarPubMed
93Ryan, BM, Kelleher, D. Refractory celiac disease. Gastroenterology 2000; 119: 243–51.CrossRefGoogle ScholarPubMed
94Card, TR, West, J, Holmes, GK. Risk of malignancy in diagnosed coeliac disease: a 24-year prospective, population-based, cohort study. Alim Pharm Therap 2004; 20: 769–75.Google ScholarPubMed
95Lohi, S, Mäki, M, Montonen, J, Knekt, P, Pukkala, E, Reunanen, A, Kaukinen, K. Malignancies in cases with screening-identified evidence of coeliac disease: a long-term population-based cohort study. Gut 2009; 58: 643–47.CrossRefGoogle ScholarPubMed
96Logan, RF. Coeliac disease. Lancet 1990; 336: 633.CrossRefGoogle ScholarPubMed
97Baer, AN, Bayless, TM, Yardley, JH. Intestinal ulceration and malabsorption syndromes. Gastroenterology 1980; 79: 754–65.CrossRefGoogle ScholarPubMed