Risk of complications in coeliac patients depends on age at diagnosis and type of clinical presentation

Background: Coeliac disease is characterised by an increased mortality mostly due to its complications. Aims: To study the risk of developing complications according to clinical presentation and age at diagnosis, a combined retrospective–prospective longitudinal study was performed in three Italian centres. Methods: Incidence of complications and mortality rates were calculated using type and age at diagnosis of coeliac disease, sex, and centre of diagnosis as predictors. Patients referred after being found to suffer from coeliac disease elsewhere were excluded. Results: Between 01/1999 and 06/2015, 2225 adult coeliac patients were directly diagnosed in our centres. 17 of them developed a complication and 29 died. In patients older than 60 years at diagnosis of coeliac disease, the risk of complication is 18 times higher than in patients diagnosed at 18–40 years and 9 times higher than in patients diagnosed at 40–60 years. Classical presentation increases the risk of complications by 7 times compared to non-classical presentation; in asymptomatic patients the risk of complication is virtually absent. Conclusions: The risk of developing complications in coeliac patients is linked to age at diagnosis of coeliac disease and type of clinical presentation. Follow-up methods of coeliac patients should be tailored according to these parameters.