Su1170 Gender Differences in Age at Diagnosis of Patients With Coeliac Disease in the Netherlands

Introduction: Micronutrient deficiencies are common in patients with newly diagnosed celiac disease, and recent guidelines on the management of celiac disease recommend assessment of serologic micronutrient levels at diagnosis.However, data to support testing patients with refractory celiac disease (RCD) are limited.Methods: Patients with concerns for RCD were seen in the Mayo Clinic Division of Gastroenterology Celiac Disease Clinic from 2000-2014.These 246 patients were reviewed to determine if they met the ACG diagnostic criteria for RCD.Age, sex, race, presenting symptoms, and refractory classification as defined by the ACG guidelines on diagnosis of RCD were compiled.Ferritin, vitamin B12, 25-hydroxy vitamin D, copper, zinc, and albumin were collected from 1 month prior to 3 months after the diagnosis of RCD.Nutrient deficiencies were tested for association with demographic characteristics, presenting symptoms, and refractory classification.Results: A total of 89 patients were included, 56 (62.9%) female with a mean age of 59.2 years.There were 71 RCD 1 and 18 RCD 2 patients.Among the 89 tested, 9 (10.1%)presented with low ferritin.Younger age (OR 0.94 (.89-1.00)) and a lack of stool symptoms (OR 0.23 (0.05-0.98)) were associated with low ferritin.Vitamin D analysis revealed 22/58 (37.9%) with low vitamin D. Male sex and weight loss were associated with low vitamin D (OR 7.25 (2.19-24.03)and OR 3.76 (1.23-11.51)respectively).Serologic vitamin B12 deficiency was noted in 8/70 (11.4%) of patients tested.There were no factors associated with vitamin B12 deficiency.Analysis of zinc showed 38/66 (57.6%) with serologic low zinc.Of the 56 tested for both albumin and zinc, 18 (32.1%)were deficient for both, and of the 55 who were tested for both copper and zinc, 7 (12.7%)were deficient in both although no significant association was found in either case.A total of 11/60 (18.3%) patients presented with serologic copper deficiency, and there were no associated demographic factors or presenting symptom complaints.34/73 (46.6%) had low albumin.Male sex )), older age (OR 1.05 (1.01-1.09)),and weight loss )) were associated with low serum albumin.Finally, for each micronutrient assessed, RCD2 status was not associated with a greater chance of deficiency.Discussion: Micronutrient deficiencies are common in patients with RCD, and these data support testing refractory patients for serologic deficiencies.This is important as there are no consistently predictive factors between micronutrients suggesting deficiency.Interestingly, type 2 RCD was not associated with a greater chance of deficiency when compared to those with RCD type 1.