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INTRODUCTION: Treatment for Celiac Disease (CD) involves lifelong elimination of dietary gluten1. Compliance to a gluten-free diet (GFD) relies on purchasing gluten-free foods, which are commonly more expensive than their gluten-containing counterparts2. This study aimed to determine whether household income affects patients’ adherence to GFD and mucosal healing. METHODS: This is a single center retrospective chart review at an urban tertiary hospital. Any adult patient diagnosed with CD was included, with the exception of those without clear documentation of initial presentation. Outcomes included demographic information, socioeconomic data, GFD adherence, and pathologic and laboratory findings of CD. Using patient zip code, cohorts were stratified by US Census Bureau household income percentiles: low income (LI) (1st-50th percentile of US income), medium income (MI) (50th-70th percentile of US income) and high income (HI) (70th-99th percentile of US income). RESULTS: 193 patients diagnosed between 1999 – 2017 were included and categorized into LI (n = 49), MI (n = 95) and HI (n = 49). LI presented at an older age (39.8 yr in LI; 39.5 yr in MI; 38.4 yr in HI) with a higher proportion of patients with Marsh 3A or greater classification (68.8% in LI; 68.0% in MI; 57.7% in HI). Non-adherence to GFD was noted to be highest in LI (16.3% in LI; 4.7% in MI, 0.0% in HI). Subsequently, LI was found prolonged mucosal healing (79.2 mo. in LI; 44.3 mo. in MI; 33.5 mo. in HI). HI had the lowest percentage of patients with Marsh 3A or greater classification on repeat encounters (25.7% in LI; 36.6% in MI; 14.3% in HI). Normalization of TTG IgA (69.2% in LI; 72.0% in MI; 84.6% in HI) and gliadin IgA (20.0% in LI; 75.0% in MI; 85.7% in HI) occurred more frequently in HI. CONCLUSION: Discussion: GFD remains a staple in the management of CD. Our study sought to evaluate the impact of socioeconomic status on GFD adherence, severity of CD, and mucosal healing. The LI group was noted to be less adherent with GFD, have more severe disease presentation, have longer time to mucosal healing, and have less normalization of TTG IgA and gliadin IgA. Future studies may focus on further determining the causation between socioeconomic status, GFD adherence and CD outcomes.

INTRODUCTION: The presenting symptoms of Celiac Disease (CD) in females were initially described as more severe and rapid in comparison to males1. However, a recent study implied these differences may not be as significant as once believed2. The primary objective of this study is to assess for sex differences in CD. METHODS: This study is a single center retrospective chart review of adult patients diagnosed with CD at an urban, tertiary hospital. Patients without clear documentation of initial presentation were excluded. Outcomes included age at diagnosis, demographic data, presenting symptoms, relevant clinical values, mode of diagnosis, and adherence to diet. RESULTS: We included 194 patients (77% females, n = 150) diagnosed between 1999 – 2017. Ethnicity was similar between sexes. Female patients had a lower mean age (38.7 yr in females; 42.0 yr in males) and lower hemoglobin at presentation (13.5 in females; 14.3 in males; P = 0.0019). Female patients on presentation had similar BMI but higher total cholesterol. Both sexes had similar presentation at time of diagnosis, most commonly GI symptoms and neurologic symptoms. More females presented with symptoms of anemia (9.3% of females; 2.3% of males). The majority of patients in each group were diagnosed by both biopsy and serology. Both sexes presented with a similar distribution of Marsh Classification and were similarly adherent to a gluten free diet. CONCLUSION: This study compared the presentation of CD between sexes. In support of recent literature, our study found that male and female patients have similar clinical presentations of CD. However, a few notable differences were noted. Namely, females presented at a younger age and more frequently presented with symptomatic anemia. Both sexes had similar marsh classification on initial diagnosis and had similar adherence to a gluten free diet. While more females carry the diagnosis of CD, clinicians should have a high index of suspicion for CD in both male and female populations.

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