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

Carolina Olano; Yéssica Pontet; Lucía Secondo; Luciana Méndez; Valentina Colistro; Alicia Aleman; Eamonn Quigley

doi:10.47892/rgp.2026.463.2228

Autores/as

Carolina Olano Gastroenterology Department, Hospital de Clínicas, UDELAR, Montevideo, Uruguay. https://orcid.org/0000-0002-4340-4051
Yéssica Pontet Gastroenterology Department, Hospital de Clínicas, UDELAR, Montevideo, Uruguay. https://orcid.org/0000-0002-1537-1280
Lucía Secondo Gastroenterology Department, Hospital de Clínicas, UDELAR, Montevideo, Uruguay. https://orcid.org/0009-0002-4800-648X
Luciana Méndez Gastroenterology Department, Hospital de Clínicas, UDELAR, Montevideo, Uruguay. https://orcid.org/0009-0007-4067-6733
Valentina Colistro Preventive and Social Medicine Department, UDELAR, Montevideo, Uruguay. https://orcid.org/0000-0002-5727-4980
Alicia Aleman Preventive and Social Medicine Department, UDELAR, Montevideo, Uruguay. https://orcid.org/0000-0002-9247-1031
Eamonn Quigley Gastroenterology Department, Hospital de Clínicas, UDELAR, Montevideo, Uruguay; Lynda K and David M Underwood Center for Digestive Health, Division of Gastroenterology and Hepatology, Houston Methodist Hospital, and Weill Cornell Medical College, Texas, USA. https://orcid.org/0000-0003-4151-7180

DOI:

https://doi.org/10.47892/rgp.2026.463.2228

Palabras clave:

Celiac Disease, Autoimmune Diseases, Uruguay

Resumen

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.

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