Daijiworld Media Network - Rohtak
Rohtak, Sep 13: Celiac disease, traditionally associated with childhood, is increasingly being diagnosed among adults and elderly people, with doctors at the Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, reporting a growing number of atypical cases.
An analysis of patients treated at PGIMS has shown that the autoimmune disorder can present with symptoms beyond the digestive system, including neurological and psychiatric problems, dental abnormalities, menstrual irregularities and reproductive issues, making diagnosis more challenging.
Celiac disease is triggered by gluten, a protein found in wheat, barley, rye and related grains. Dr Parveen Malhotra, Senior Professor and Head of the Department of Medical Gastroenterology at PGIMS, said the prevalence of the disease in India is estimated at around one per cent and is more commonly reported in northern states such as Haryana, where wheat forms a major part of the diet.
More than 1,100 patients have been diagnosed with celiac disease at PGIMS over the past decade. Of these, around 540, or 49 per cent, were adults or elderly people, while nearly 330 patients, or 30 per cent, had atypical symptoms involving neurological, psychiatric, dental, menstrual or reproductive problems.
Dr Malhotra said more than 30 adults and elderly patients had been diagnosed with the condition at the institute in the past six months alone. The oldest patient was a 78-year-old woman.
The department currently diagnoses around one to two new cases every week, with greater awareness and the wider availability of blood tests helping doctors identify patients who might otherwise remain undiagnosed.
Dr Malhotra said the clinical pattern of celiac disease was changing. Earlier, the condition was primarily associated with children experiencing poor growth, abdominal pain, diarrhoea or constipation. Increasingly, however, patients are being diagnosed following unexplained nutritional deficiencies, persistent anaemia, hormonal problems and other symptoms unrelated to the digestive system.
He advised screening for children with poor growth, persistent abdominal symptoms, recurrent anaemia, reduced food intake, dental enamel defects or a family history of celiac disease. In women, delayed or irregular menstruation and unexplained infertility may also warrant testing.
Dr Vani Malhotra, Professor of Obstetrics and Gynaecology at PGIMS, said some women with unexplained infertility were subsequently diagnosed with celiac disease and conceived after adopting a gluten-free diet. She also stressed the importance of screening family members.
Dr HK Aggarwal, Vice Chancellor of the University of Health Sciences, Rohtak, said diagnostic facilities, including antibody testing, endoscopy and biopsy where required, were being provided free of cost at PGIMS.
He said lifelong and strict avoidance of gluten remains the only established treatment for celiac disease. Continued consumption of gluten can result in persistent nutritional deficiencies and poor growth and may lead to serious long-term complications.
PGIMS Senior Professor-cum-PRO Dr Manjunath said the rising number of atypical cases highlighted the need for doctors to look beyond conventional gastrointestinal symptoms while evaluating patients.