Extraintestinal manifestations of coeliac disease

Abstract

Coeliac disease is a common disorder that can arise at any age and typically presents with a broad spectrum of symptoms. The disease is thought to be underdiagnosed, in part owing to the fact that coeliac disease is often characterized by associated conditions and extraintestinal manifestations that can misdirect and impede diagnosis. Some of these manifestations are direct consequences of autoimmunity, such as dermatitis herpetiformis or gluten ataxia, whereas others are indirectly related to inflammation and/or malabsorption including anaemia, osteoporosis, short stature and delayed puberty. Any organ from the central nervous system to joints, liver or teeth can be affected. In some cases, extraintestinal symptoms are the only clinical manifestations of coeliac disease or occur in conjunction with diarrhoea and malabsorptive symptoms. An increased awareness among medical practitioners of the variety of extraintestinal manifestations of coeliac disease is essential to improve diagnosis and treatment.

Celiac Disease and Anorexia Nervosa: A Nationwide Study

“…Common presenting symptoms include gastrointestinal complaints, loss of appetite, fatigue, and, in children, stunted growth and pubertal delay. 3 There are also numerous extraintestinal manifestations of CD, including psychiatric comorbidity. 4 Anorexia nervosa (AN) is an eating disorder associated with underweight, fear of weight gain, and disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight on self-evaluation, or persistent lack of recognition of the seriousness of the low weight.…”

Fluctuation of liver transaminases with gluten-free diet compliance of a patient with celiac disease and autoimmune hepatitis; a case report

“…Many organs or systems such as cardiac, neurological, bone, skin, liver, and endocrin may be involved in the course of CD (13)(14)(15)(16)(17)(18)(19). Although it is an intestinal autoimmune disease, as the diagnostic age of CD getting older, the disease presents itself with complaints that not directed to gastrointestinal tract.…”

Adult Celiac Disease: The Importance of Extraintestinal Manifestations

“…In addition, many patients do not have diarrhea nor classical signs of malnutrition [1,3] . Thus, doctors must be aware of CD presentation with atypical symptoms since many patients may seek medical advice because of them, as it was the case in our patient.…”

“…However, in most adult patients, gastrointestinal symptoms are subtle or even absent and clinical suspicion should be oriented to the extraintestinal manifestations (nonclassic or atypical CD), including anemia, skin disorders, neuromuscular symptoms, bone disease, and abnormal liver function tests. A life-long gluten-free diet is mandatory, achieving clinical and histological recovery in most patients [3] .…”

“…It is driven by the ingestion of food containing gluten, a protein conglomerate whose main component is gliadin, present in wheat, rye, barley, and processed foods [1][2][3][4][5] . CD must be distinguished from wheat allergy and nonceliac gluten sensitivity that may have a similar clinical presentation [1,2] .…”