The Clinical Pattern of Subclinical/Silent Celiac Disease: An Analysis on 1026 Consecutive Cases Figure 1

TLDR

In Italy, subclinical/silent celiac disease is more commonly identified in adults, and future prospective studies are needed to determine whether the lower prevalence in children is real or apparent. The study aimed to characterize the demographic, clinical, and epidemiological features of subclinical/silent celiac disease in Italy through a multicenter analysis from 1990 to 1994. The multicenter study included 1,026 patients (644 children, 382 adults) across 42 centers between 1990 and 1994. Prevalence of subclinical/silent celiac disease rose significantly in both adults and children during the study, remained lower in children, likely due to increased diagnostic awareness; regional differences in diagnosis disappeared by 1994; iron‑deficiency anemia was the most common extra‑intestinal symptom, with diabetes and atopy frequently co‑present, and 25.9 % of cases had another disease, higher in adults.

Abstract

OBJECTIVE: The demographic, clinical, and epidemiological features of subclinical/silent celiac disease in Italy were analyzed in a multicenter study carried out with the participation of 42 centers, in the years between 1990 and 1994. METHODS: One thousand twenty-six subclinical/silent patients (644 children and 382 adults, 702 women and 324 men) were considered eligible for the study. RESULTS: The prevalence of the subclinical/silent form increased significantly during the study both in adults (p < 0.001) and in children (p < 0.005), but its prevalence was always lower (p < 0.001) in children than in adults. This increase appears more likely due to a greater diagnostic awareness and to a better use of screening than to a higher number of subclinical/silent cases. Whereas in 1990 a significantly higher proportion (p < 0.001) of subclinical/silent celiac patients was diagnosed in Northern Italy rather than in Southern-Insular Italy, both in adults (46.7%vs 17.2%) and in children (22.0%vs 9.0%), in 1994 such a difference was no longer conspicuous. Both in children and in adults, iron-deficiency anemia appeared to be the most frequent extraintestinal symptom, followed by short stature in children and cutaneous lesions of dermatitis herpetiformis in adults. In 25.9% of the cases another disease was present, with a significantly higher frequency (p < 0.05) in adults (30.1%) than in children (20.7%). Diabetes and atopy appeared to be the most frequently associated conditions both in children and in adults. CONCLUSIONS: This study has provided an analysis of the largest series of subclinical/silent celiac disease reported to date. In Italy, this form is most frequently recognized in adults, and prospective studies will clarify whether the lower frequency observed in children is a real or apparent phenomenon.