Trends in the clinical presentation of celiac disease over time: a study from a national university hospital in Uruguay

Abstract

The clinical presentation of celiac disease (CD) has evolved over recent decades. Understanding these shifts is essential to strengthen diagnostic suspicion and improve detection. Objectives: To evaluate temporal trends in the clinical presentation of CD at a university hospital in Uruguay. Materials and methods: A retrospective cross-sectional study, approved by the institutional ethics committee, was conducted. It included patients diagnosed with CD between 1970 and 2023 who presented positive IgA anti-tissue transglutaminase antibodies and compatible duodenal histology (Marsh III). Patients were categorized by diagnostic period: before 1986, 1986-1995, 1996-2005, 2006-2015, and 2016-2023. Clinical presentation was classified according to the Oslo criteria as classical, non-classical, or asymptomatic. Results: A total of 331 patients were included; 84% were female. The mean age at diagnosis was 32 years (range 0-77), showing a progressive shift toward adulthood diagnosis. Overall, 61% presented with classical CD, 27% with non-classical CD, and 12% were asymptomatic. Linear trend analysis demonstrated a significant decrease in classical CD (slope -15.7, p=0.0003), accompanied by an increase in non-classical (slope 12.5, p=0.00267) and asymptomatic presentations (slope 3.15, p=0.042). Conclusions: Over the past four decades, CD presentation has shifted toward later diagnosis and away from classical phenotypes, with an increasing recognition of non-classical and asymptomatic forms. These findings underscore the importance of maintaining clinical suspicion beyond traditional malabsorptive presentations.