SYMPTOMS, FEATURES AND COMPLICATIONS Of CELIAC DISEASE

New prevalence figures (February 2003) indicate 1 in 133 healthy individuals will develop Celiac Disease, estimating about 1.5 million people. Genetically, first degree relatives of celiacs are affected about 1 in 22, and 2nd degree relatives are also at risk (1:39). Celiac Disease appears to be a more common but neglected disorder than has generally been recognized in the United States.

Persons seem to be diagnosed with CD more in years 40 to 60, with atypical symptoms, making it harder for doctors to determine diagnosis. The doctors tend to treat each symptom separately, rather than see the whole picture – and then THINK about Celiac Disease as a possibility -- thus delaying correct diagnosis.

It is extremely important for celiacs and people with dermatitis herpetiformis to keep strictly gluten free, once officially diagnosed, for the rest of your life. Because we will most likely ingest some gluten inadvertently, it behooves us to make sure we are not willingly cheating. One-eighth of a teaspoon of gluten causes damages in the small intestine.
(1) Continual cheating may result in the inability of some villi to fully regenerate and allow complete absorption. Malabsorption can affect any organ of the body.
(2) Development of other typical and/or atypical symptoms is at risk when one is not on a good GF diet.
(3) With continued cheating that may compromise the immune system, there is a possibility of developing another immune system disorder.
(4) Also be aware that another possible long-term problem is decreased bone density leading to OSTEOPOROSIS.
(5) The risk of intestinal LYMPHOMA is increased to some extent in people with Celiac Disease who are not on a gluten-free diet or in those who “cheat” regularly and knowingly. Any chronic inflammation can promote a cancer in the body. However, when one is on a strict GF diet and the gut heals completely, the risk of cancer is reduced to about that of the general population.

The potential to develop another immune disorder, osteoporosis earlier than usual, or intestinal cancer should give us good incentive to always stay on a strict gluten-free diet.

The malabsorption of nutrients with Celiac Disease can affect any organ of the body, and thus cause symptoms totally seemingly unrelated to the digestive system. This sheet will help make you aware of many of the signs and symptoms of CD, as well as complications of undiagnosis or cheating on the gluten-free diet (the only treatment). This list is not all-inclusive.

Common Features:

Adults: Iron deficiency anemia, severe diarrhea, steatorrhea, chronic fatigue, abdominal pain, weight loss, nutritional & vitamin deficiencies, lactose intolerance, etc.

Children: Chronic severe diarrhea, Failure to thrive, nausea, projectile vomiting, abdominal distention, malabsorption, malnutrition (with or without vomiting & diarrhea), emotional & behavior concerns, lactose intolerance, etc.

Less Common Features ("atypical"):

Adults: Constipation, weight gain, joint/bone pain; muscle weakness, etc.

Youths: Short stature, delayed puberty,
Constipation, etc.

Gastrointestinal Manifestations:

Recurrent aphthous stomatitis;
Steatorrhea (foul smelling floaty stools);
Abnormal bowel bacterial flora;
Vomiting;
Lactose intolerance, lactase deficiency; Glossitis or stomatitis.

Recurrent abdominal pain;
Flatulence;
Enlarged liver, pruritis
Anorexia (loss of appetite) or excessive appetite;
Ulcerative colitis or microscopic colitis.

Hematopoetic System Manifestations:

Anemia, iron & folic acid deficiency;
Marked atrophy of the spleen.

Deficiency of coagulation factors;
Pallor, headaches, dizziness & dyspnea.

Musculoskeletal System Manifestations:

Bone pain;
Osteopenia, osteoporosis;
Muscular weakness.

Rickets;
Dental defects;
Compression fractures.

Skin, Hair, and Nails Symptoms:

Dry, scaly, hyperpigmented, itchy skin;
Acne rosacea, psoriasis, or eczema;
Brittle and/or abnormal nails.

Dermatitis Herpetiformis;
Alopecia (hair loss);
Clubbing of fingers.

Nervous System Features:

Peripheral neuropathy;
Polyneuritis;
Chronic hives.

Myelopathy;
Encephalomyeloradiculopathy;

Endocrine, Immunologic Systems:

Diabetes type 1;
Secondary hyperparathyroidism;
Developing another autoimmune disorder.

Hypopituitarism;
Thyroid disorders;
Autoimmune collagen diseases.

Psychological Features:

Nervousness;
Lack of ability to focus.

Inattention; behavioral concerns; Depression.

Reproductive System Features:

Female: Infertility;
menstrual disorders; delayed menarche; early menopause, miscarriages, etc.

Male: Decreased fertility,
impotence,
hypogonadism

ASSOCIATIONS WITH CELIAC DISEASE: Autoimmune Disorders

Dermatitis Herpetiformis;
IgA deficiency;
Type 1 diabetes;
Autoimmune thyroid diseases;
Sjogren's syndrome;
Rheumatoid Arthritis;
IgA nephropathy;
Irritable Bowel Disease;
Autoimmune hepatitis;
Myasthenia Gravis;
Renaud's syndrome;

Congenital heart disease;
Recurrent pericarditis;
Addison's disease;
Systemic lupus erythematosus;
Down Syndrome;
Sarcoidosis;
Cystic Fibrosis;
Lung cavities;
Pulmonary Hemosiderosis;
Inflammatory bowel diseases;
Primary biliary cirrhosis;
Vasculitis;
Polymyositis;
Schizophrenia.

Complications of Undiagnosed or Untreated Celiac Disease

Refractory or Collagenous Sprue Carcinoma of the oropharynx, esophagus, and small bowel

Enteropathy associated T-cell lymphoma;
Ulcerative jejunoileitis;

References:

 

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Updated 16Feb03