Celiac Disease
Clinical
- HLA linked, first degree relatives at 10x risk
- Serologic screening of relatives is frequently used to find subclinical, pre-symptomatic cases
- May present at any age but most in childhood to thirties
- Presentation in childhood
- Diarrhea, steatorrhea
- Growth retardation, weight loss
- Abdominal pain
- Late onset presentation (>45)
- Short stature
- Infertility, amenorrhea
- Iron or folate deficiency
- Osteoporosis
- Diarrhea not prominent
- Malabsorption only on tests
- Refractory sprue
- Defined as loss of clinical response to gluten free diet
- Causes include
- Associated diseases
- Dermatitis herpetiformis (DH)
- 70-90% of DH patients have celiac disease
- 10% of celiac disease patients have DH
- Lymphocytic colitis, collagenous colitis, collagenous gastritis
- Hyposplenism
- Various autoimmune diseases
- Insulin dependent diabetes mellitus
- Sjogren syndrome
- Autoimmune liver disease
- Autoimmune thyroiditis
- Autoimmune myocarditis
- Systemic lupus erythematosus
- Increased risk of esophageal squamous carcinoma
- Increased risk of small intestinal carcinoma
- Increased risk of enteropathy type T cell lymphoma
- Some of these can occur even in patients with sub-clinical celiac disease
- Gluten free diet can resolve or decrease the risk of occurrence of these disorders
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