Extraintestinal Manifestations of Celiac Disease

Abstract

Case finding for celiac disease (CD) is becoming increasingly common practice and is conducted in a wide range of clinical situations ranging from the presence of gastrointestinal symptoms to failure to thrive in children, prolonged fatigue, unexpected weight loss and anemia. Case finding is also performed in associated conditions, such as autoimmune thyroid disease, dermatitis herpetiformis and type 1 diabetes, as well as in patients with irritable bowel syndrome, unexplained neuropsychiatric disorders and first-degree relatives of patients with diagnosed CD. This aggressive active case finding has dramatically changed the clinical characteristics of newly diagnosed patients. For instance, higher numbers of patients who present with extraintestinal symptoms are now being diagnosed with CD. Current recommendations state that due to a high risk for complications if the disease remains undiagnosed, patients with extraintestinal symptoms due to CD require appropriate diagnosis and treatment. Despite criticism regarding the cost-effectiveness of case finding in CD, such an aggressive approach has been considered cost-effective for high-risk patients. The diagnosis of CD among patients with extraintestinal symptoms requires a high degree of awareness of the clinical conditions that carry a high risk for underlying CD. Also, understanding the correct use of specific serology and duodenal histology is key for an appropriate diagnostic approach. Both procedures combined are able to confirm diagnosis in the vast majority of cases. However, in certain circumstances, serology and even duodenal histology cannot confirm or rule out CD. A common cause of negative IgA serology is IgA deficiency. For such eventuality, IgG-based serological tests can help confirm the diagnosis. Importantly, some histologically diagnosed cases still remain seronegative despite exclusion of IgA deficiency. On the other hand, duodenal histology may be normal despite the presence of CD-specific antibodies and active CD. This has been clearly demonstrated in some cases of untreated dermatitis herpetiformis, but may also be due to the patchy condition of CD or lesions that are not adequately recognized by nonexpert endoscopists and/or pathologists. The effectiveness of agluten-free diet depends on the clinical end point addressed. A good example is the outcome of bone loss. While risk for fracture normalizes after the first year of dietary treatment, bone parameters measured by densitometry may not be normalized in the long-term follow-up. Moreover, it is still unclear how far an early gluten-free diet will positively affect associated autoimmune diseases like type 1 diabetes and autoimmune thyroiditis.

Calidad de vida en adultos del Paraguay con enfermedad celiaca

“…Esto podría interpretarse como una forma de aislamiento social para evitar la ansiedad o vulnerabilidad relacionada con las comidas 24,29 . Otra posibilidad es la presencia de depresión, hecho muy asociado a la EC por los sentimientos de miedo, negación y ansiedad que genera un nuevo estilo de vida 6,26,30 . En efecto, 25% de los pacientes manifestaron sentirse deprimidos por padecer la EC y 28% considera que no hay suficientes elecciones alimentarias para su tratamiento.…”

“…20 . Artículos de revisión a nivel mundial mencionan prevalencias menores (15-25%) 30 . Esta diferencia se explicaría a que muchos celiacos confunden algunas dermopatías con la dermatitis herpetiforme.…”

The Association of Celiac Disease With Other Autoimmune Diseases in Children

“…CD may be associated with various skin manifestations, such as dermatitis herpetiformis (DH), psoriasis, alopecia areata and vitiligo [39][40][41]. DH is most frequently found in adolescents, young and middle-aged adults.…”

“…GFD is standard treatment for DH with excellent clinical response. Since the reintroduction of gluten in a diet after clinical recovery on GFD triggers relapses of cutaneous and intestinal lesions, DH is regarded as skin manifestation of CD [39].…”

Serum brain‐derived neurotrophic factor in children with coeliac disease

“…1 Among others, it has also been linked to neurologic and mental disorders. The disease can be manifested typically with gastrointestinal symptoms, it can be silent, or it can have an atypical form with several extra-intestinal manifestations.…”