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Coeliac disease in old age: 'a catch in the rye'.

Coeliac disease has been viewed as a disease of children and young adults, presenting with weight loss, steatorrhoea, anaemia and evidence of folate, iron or vitamin D deficiency [1]. Early studies reported that only 4% of new diagnoses of coeliac disease were made in patients aged over 60 [2] but the Coeliac Society estimates that 21 % of new patient members now fall into this age group [3] and a recent study reports that 34.1 % of all new patients diagnosed with coeliac disease are in the seventh decade or above [4]. Swinson et al. [5] demonstrated a bimodal distribution for age at time of diagnosis for adult coeliac disease, with an initial peak in the fourth decade (predominantly women) and a later peak in the sixth and seventh decades (mostly men). The female: male ratio is approximately 2 : 1 in adults overall [6] but may be more even in elderly subjects [7]. However, the recently developed screening tests for the presence of 19A ':l!-gliadin antibody or 19A anti-endomysial antibody have shown that 60% of patients with gluten-sensitive enteropathy may be asymptomatic and have confirmed associations with neurological disorders [8] and insulindependent diabetes mellitus [9]. Coeliac disease is therefore likely to be diagnosed more commonly in geriatric practice.