Celiac disease may trigger anaemia, infertility, nerve issue: Rohtak PGIMS study

Celiac disease, traditionally regarded as a childhood disorder, is increasingly being diagnosed among adults and the elderly, with doctors at the PGIMS, Rohtak, reporting a growing number of atypical cases.

An analysis of celiac disease patients at PGIMS has revealed that the condition may present with symptoms beyond the digestive system, including neurological and psychiatric problems, dental abnormalities, menstrual irregularities and reproductive issues, often making diagnosis more challenging.

Celiac disease is an autoimmune disorder triggered by gluten, a protein found in wheat, barley, rye and related grains. While its prevalence in India is estimated around 1 per cent, the disease is more commonly reported in northern states such as Haryana, where wheat is a staple part of the diet, said Dr Parveen Malhotra, Senior Professor and Head of the Department of Medical Gastroenterology at PGIMS.

“Over 1,100 patients have been diagnosed with celiac disease at the institute over the past one decade. Of these, around 540 (49 per cent) are adults or elderly, while nearly 330 (30 per cent) have presented with atypical symptoms involving neurological, psychiatric, dental, menstrual or reproductive problems. In the last six months alone, we have diagnosed more than 30 patients in the adult and elderly age group. The oldest was a 78-year-old woman,” Dr Malhotra added.

He informed that the department currently diagnoses around one-two new cases every week, with increased awareness and the wider use of blood tests helping doctors identify patients who might otherwise remain undiagnosed.

“The changing pattern represents a significant shift in the clinical spectrum of celiac disease. Earlier, the disease was commonly associated with children showing poor growth, abdominal pain, diarrhoea or constipation. Increasingly, however, patients are being identified because of unexplained nutritional deficiencies, persistent anaemia, hormonal problems and other non-gastrointestinal symptoms,” Dr Malhotra pointed out.

He advised that children with poor growth, persistent abdominal symptoms, recurrent anaemia, reduced food intake, dental enamel defects or a family history of celiac disease should be screened. 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 otherwise unexplained infertility were subsequently diagnosed with celiac disease and conceived after following a gluten-free diet. She also stressed the importance of screening family members.

Dr HK Aggarwal, Vice Chancellor, University of Health Sciences, Rohtak, said diagnostic tests, including antibody testing, endoscopy and biopsy where required, are being provided free of cost at the PGIMS.

“At present, the only established treatment is lifelong strict avoidance of gluten. Continued gluten consumption may also lead to persistent nutritional deficiencies, poor growth and, in the long term, serious complications,” Dr Aggarwal added.

PGIMS Senior Professor-cum- PRO Dr Manjunath said the increasing number of atypical cases underlined the need for physicians to look beyond conventional gastrointestinal symptoms.