Findings are based on evaluations of patients from 1952 to 2004 who had celiac disease, a condition where patients cannot tolerate gluten, a protein in foods containing wheat, rye and barley.

This study looked at a large group of 590 patients with a diagnosis of celiac disease established by biopsy. Researchers grouped patients based on year of diagnosis and compared over time trends in age at diagnosis, duration of symptoms, mode of presentation including whether they presented with symptoms such as diarrhea, anemia or bone disease or whether the condition was diagnosed through screening. Researchers also looked for presence of malignancy.

There was a highly significant negative linear trend in presentation with diarrhea over time and a positive linear trend in patients detected by screening. Trends show patients were diagnosed at an older age since 1980, and there was a significant downward trend in those diagnosed as children or with malignancy. Over the 52 years, there was a markedly significant negative trend in the duration of symptoms.

"Fewer patients present with diarrhea and more are detected through screening. The majority of patients now present as 'silent' celiac disease, with minimal or no symptoms," explained Devi Rampertab, M.D., one of the investigators.

Celiac disease is an autoimmune inflammatory disease of the small intestine. In celiac disease, patients cannot tolerate the protein gluten. The condition causes an autoimmune reaction that damages the small intestine and causes problems absorbing nutrients from food as well as a range of gastrointestinal and other symptoms. Celiac disease generally responds to a gluten-free diet.

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Heiko Pohl, M.D. and Douglas Robertson, M.D. of the VA Medical Center in White River Junction, VT performed a systematic review of all case-control or controlled cohort studies that examined risk of esophageal adenocarcinoma across multiple categories of body mass index. Among nine studies between 1996 and 2004 involving a total of 1,103 patients with esophageal cancer, seven studies found obesity to be a risk factor; two found no association. Four studies found a significant dose-dependent association between body mass index and risk. As BMI increased so did risk of esophageal adenocarcinoma.

Dr. Pohl and Dr. Robertson found those in the highest BMI group were 3.5 times more likely to develop esophageal adenocarcinoma than patients in the lowest BMI group, which included individuals of normal weight. Adjusting for other possible risk factors such as GERD, smoking or a diet low in vegetables, had minimal affect on this outcome.

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