Celiac disease history and symptoms: Difference between revisions

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Latest revision as of 20:50, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Celiac disease may present with typical symptoms such as diarrhea, steatorrhea, weight loss, and growth failure or non-typical symptoms not involving the gastrointestinal tract. The classic presentation of celiac disease is more common in young children, consisting primarily of gastrointestinal symptoms. In adults, the presentation of celiac disease is often more subtle and can be mistaken for irritable bowel syndrome. Some patients lack any evident gastrointestinal symptoms and instead present with nutritional deficiencies (most commonly iron deficiency) or extra-intestinal symptoms, or are asymptomatic.

History

A detailed and thorough history from the patient is necessary. It provides insight into the cause, precipitating factors and associated comorbid conditions. Specific areas of focus when obtaining a history from the patient with celiac disease include:^[1]

Unexplained gastrointestinal symptoms
Chronic diarrhea
Symptoms of fatigue and tiredness (iron deficiency anemia)
Skin rash consistent with dermatitis herpetiformis
Family history of celiac disease and inflammatory bowel disease

Symptoms

Celiac disease may present with typical symptoms such as diarrhea, steatorrhea, weight loss, and growth failure or non-typical symptoms involving extra-intestinal manifestations. The classic presentation of celiac disease is more common in young children, consisting primarily of gastrointestinal symptoms. In adults, the presentation of celiac disease is often more subtle and can be mistaken for irritable bowel syndrome. Some patients lack any evident gastrointestinal symptoms and instead present with nutritional deficiencies (most commonly iron deficiency) or extra-intestinal symptoms, or are asymptomatic.

The following table summarizes the symptoms of celiac disease in adults.^[2]^[3]^[4]^[5]^[6]^[7]

Symptoms frequency	Symptoms
	Intestinal	Extra-intestinal
	Intestinal	Hematologic	Dermatologic	Neurologic	Musculoskeletal	Hepatic	Renal	Cardiac
Common Symptoms	Recurrent abdominal pain Diarrhea Vomiting Occult blood in stool Steatorrhea Weight loss	Bruising Fatigue	Glossitis Angular cheilosis Lichen planus	Dementia Depression Altered gait	Back pain Flank tenderness	Hepatosplenomegaly	-	-
Less common symptoms	Constipation Flatulence Secondary lactose intolerance Dyspepsia	Bleeding	Blisters Maculopapular rash Pustules Alopecia Erosive buccal lesions Eczema	Ataxia Seizures	Arthralgia Deformities	Ascites Jaundice Gynecomastia Spider angioma	Hematuria Dysuria	Chest pain Fatigue Shortness of breath Edema

In children gastrointestinal symptoms predominate than extra-intestinal symptoms in celiac disease. Symptoms include:^[8]^[9]^[10]

Common symptoms of celiac disease in children

Less common symptoms of celiac disease in children

References

↑ Green PH, Cellier C (2007). "Celiac disease". N. Engl. J. Med. 357 (17): 1731–43. doi:10.1056/NEJMra071600. PMID 17960014.
↑ Zipser RD, Patel S, Yahya KZ, Baisch DW, Monarch E (2003). "Presentations of adult celiac disease in a nationwide patient support group". Dig. Dis. Sci. 48 (4): 761–4. PMID 12741468.
↑ Lasa JS, Zubiaurre I, Soifer LO (2014). "Risk of infertility in patients with celiac disease: a meta-analysis of observational studies". Arq Gastroenterol. 51 (2): 144–50. PMID 25003268.
↑ Freeman HJ (2008). "Neurological disorders in adult celiac disease". Can. J. Gastroenterol. 22 (11): 909–11. PMC 2661192. PMID 19018335.
↑ Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA (2013). "Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients". Nutrients. 5 (10): 3975–92. doi:10.3390/nu5103975. PMC 3820055. PMID 24084055.
↑ Casella G, Antonelli E, Di Bella C, Villanacci V, Fanini L, Baldini V, Bassotti G (2013). "Prevalence and causes of abnormal liver function in patients with coeliac disease". Liver Int. 33 (7): 1128–31. doi:10.1111/liv.12178. PMID 23601438.
↑ Troncone R, Discepolo V (2014). "Celiac disease and autoimmunity". J. Pediatr. Gastroenterol. Nutr. 59 Suppl 1: S9–S11. doi:10.1097/01.mpg.0000450394.30780.ea. PMID 24979198.
↑ Bottaro G, Failla P, Rotolo N, Sanfilippo G, Azzaro F, Spina M, Patane R (1993). "Changes in coeliac disease behaviour over the years". Acta Paediatr. 82 (6–7): 566–8. PMID 8338991.
↑ Rashid M, Cranney A, Zarkadas M, Graham ID, Switzer C, Case S, Molloy M, Warren RE, Burrows V, Butzner JD (2005). "Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children". Pediatrics. 116 (6): e754–9. doi:10.1542/peds.2005-0904. PMID 16322131.
↑ van Rijn JC, Grote FK, Oostdijk W, Wit JM (2004). "Short stature and the probability of coeliac disease, in the absence of gastrointestinal symptoms". Arch. Dis. Child. 89 (9): 882–3. doi:10.1136/adc.2004.057851. PMC 1763207. PMID 15321874.

Template:WH Template:WS

[pmid17960014-1] Green PH, Cellier C (2007). "Celiac disease". N. Engl. J. Med. 357 (17): 1731–43. doi:10.1056/NEJMra071600. PMID 17960014.

[pmid12741468-2] Zipser RD, Patel S, Yahya KZ, Baisch DW, Monarch E (2003). "Presentations of adult celiac disease in a nationwide patient support group". Dig. Dis. Sci. 48 (4): 761–4. PMID 12741468.

[pmid25003268-3] Lasa JS, Zubiaurre I, Soifer LO (2014). "Risk of infertility in patients with celiac disease: a meta-analysis of observational studies". Arq Gastroenterol. 51 (2): 144–50. PMID 25003268.

[pmid19018335-4] Freeman HJ (2008). "Neurological disorders in adult celiac disease". Can. J. Gastroenterol. 22 (11): 909–11. PMC 2661192. PMID 19018335.

[pmid24084055-5] Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA (2013). "Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients". Nutrients. 5 (10): 3975–92. doi:10.3390/nu5103975. PMC 3820055. PMID 24084055.

[pmid23601438-6] Casella G, Antonelli E, Di Bella C, Villanacci V, Fanini L, Baldini V, Bassotti G (2013). "Prevalence and causes of abnormal liver function in patients with coeliac disease". Liver Int. 33 (7): 1128–31. doi:10.1111/liv.12178. PMID 23601438.

[pmid24979198-7] Troncone R, Discepolo V (2014). "Celiac disease and autoimmunity". J. Pediatr. Gastroenterol. Nutr. 59 Suppl 1: S9–S11. doi:10.1097/01.mpg.0000450394.30780.ea. PMID 24979198.

[pmid8338991-8] Bottaro G, Failla P, Rotolo N, Sanfilippo G, Azzaro F, Spina M, Patane R (1993). "Changes in coeliac disease behaviour over the years". Acta Paediatr. 82 (6–7): 566–8. PMID 8338991.

[pmid16322131-9] Rashid M, Cranney A, Zarkadas M, Graham ID, Switzer C, Case S, Molloy M, Warren RE, Burrows V, Butzner JD (2005). "Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children". Pediatrics. 116 (6): e754–9. doi:10.1542/peds.2005-0904. PMID 16322131.

[pmid15321874-10] van Rijn JC, Grote FK, Oostdijk W, Wit JM (2004). "Short stature and the probability of coeliac disease, in the absence of gastrointestinal symptoms". Arch. Dis. Child. 89 (9): 882–3. doi:10.1136/adc.2004.057851. PMC 1763207. PMID 15321874.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Celiac disease}}
-{{CMG}}
+{{CMG}} ; {{AE}} {{ADG}}
 ==Overview==
+Celiac disease may present with typical [[symptoms]] such as [[Diarrhea|diarrhea,]] [[steatorrhea]], [[weight loss]], and [[growth failure]] or non-typical [[symptoms]] not involving the [[gastrointestinal tract]]. The classic presentation of celiac disease is more common in young children, consisting primarily of [[Gastrointestinal tract|gastrointestinal]] [[symptoms]]. In adults, the presentation of celiac disease is often more subtle and can be mistaken for [[irritable bowel syndrome]]. Some patients lack any evident [[gastrointestinal]] [[symptoms]] and instead present with [[nutritional deficiencies]] (most commonly [[iron deficiency]]) or extra-intestinal [[symptoms]], or are [[asymptomatic]].
 ==History==
-A detailed and thorough history from the patient is necessary. It provides insight into the cause, precipitating factors and associated comorbid conditions. Specific areas of focus when obtaining a history from the patient with celiac disease include:<ref name="pmid17960014">{{cite journal |vauthors=Green PH, Cellier C |title=Celiac disease |journal=N. Engl. J. Med. |volume=357 |issue=17 |pages=1731–43 |year=2007 |pmid=17960014 |doi=10.1056/NEJMra071600 |url=}}</ref>
+A detailed and thorough history from the patient is necessary. It provides insight into the cause, precipitating factors and associated [[Comorbidity|comorbid]] conditions. Specific areas of focus when obtaining a history from the patient with celiac disease include:<ref name="pmid17960014">{{cite journal |vauthors=Green PH, Cellier C |title=Celiac disease |journal=N. Engl. J. Med. |volume=357 |issue=17 |pages=1731–43 |year=2007 |pmid=17960014 |doi=10.1056/NEJMra071600 |url=}}</ref>
-*Unexplained gastrointestinal symptoms
+*Unexplained [[Gastrointestinal diseases|gastrointestinal symptoms]]
-*Chronic diarrhea
+*[[Chronic diarrhea]]
-*Symptoms of fatigue and tiredness (iron deficiency anemia)
+*[[Symptoms]] of [[fatigue]] and [[tiredness]] ([[iron deficiency anemia]])
-*Skin rash consistent with dermatitis herpetiformis
+*[[Skin rash]] consistent with [[dermatitis herpetiformis]]
-*Family history of celiac disease and inflammatory bowel disease
+*[[Family history]] of celiac disease and [[inflammatory bowel disease]]
 ==Symptoms==
-Celiac disease can present with classical symptoms such as diarrhea, steatorrhea, weight loss, and growth failure or non-classical symptoms involving outside GI tract. The classic presentation of celiac disease is more common in young children, consisting primarily of gastrointestinal symptoms. In adults, the presentation of celiac disease is often more subtle and can be mistaken for irritable bowel syndrome. Some patients lack any evident gastrointestinal symptoms and instead present with nutritional deficiencies (most commonly iron deficiency) or extra-intestinal symptoms, or are asymptomatic.
+Celiac disease may present with typical [[symptoms]] such as [[Diarrhea|diarrhea,]] [[steatorrhea]], [[weight loss]], and [[growth failure]] or non-typical [[symptoms]] involving extra-intestinal manifestations. The classic presentation of celiac disease is more common in young children, consisting primarily of [[Gastrointestinal tract|gastrointestinal]] [[symptoms]]. In adults, the presentation of celiac disease is often more subtle and can be mistaken for [[irritable bowel syndrome]]. Some patients lack any evident [[gastrointestinal]] [[symptoms]] and instead present with [[nutritional deficiencies]] (most commonly [[iron deficiency]]) or extra-intestinal [[symptoms]], or are [[asymptomatic]].
-The following table summarizes the symptoms of celiac disease in adults.
+'''The following table summarizes the symptoms of celiac disease in adults.'''<ref name="pmid12741468">{{cite journal |vauthors=Zipser RD, Patel S, Yahya KZ, Baisch DW, Monarch E |title=Presentations of adult celiac disease in a nationwide patient support group |journal=Dig. Dis. Sci. |volume=48 |issue=4 |pages=761–4 |year=2003 |pmid=12741468 |doi= |url=}}</ref><ref name="pmid25003268">{{cite journal |vauthors=Lasa JS, Zubiaurre I, Soifer LO |title=Risk of infertility in patients with celiac disease: a meta-analysis of observational studies |journal=Arq Gastroenterol |volume=51 |issue=2 |pages=144–50 |year=2014 |pmid=25003268 |doi= |url=}}</ref><ref name="pmid19018335">{{cite journal |vauthors=Freeman HJ |title=Neurological disorders in adult celiac disease |journal=Can. J. Gastroenterol. |volume=22 |issue=11 |pages=909–11 |year=2008 |pmid=19018335 |pmc=2661192 |doi= |url=}}</ref><ref name="pmid24084055">{{cite journal |vauthors=Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA |title=Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients |journal=Nutrients |volume=5 |issue=10 |pages=3975–92 |year=2013 |pmid=24084055 |pmc=3820055 |doi=10.3390/nu5103975 |url=}}</ref><ref name="pmid23601438">{{cite journal |vauthors=Casella G, Antonelli E, Di Bella C, Villanacci V, Fanini L, Baldini V, Bassotti G |title=Prevalence and causes of abnormal liver function in patients with coeliac disease |journal=Liver Int. |volume=33 |issue=7 |pages=1128–31 |year=2013 |pmid=23601438 |doi=10.1111/liv.12178 |url=}}</ref><ref name="pmid24979198">{{cite journal |vauthors=Troncone R, Discepolo V |title=Celiac disease and autoimmunity |journal=J. Pediatr. Gastroenterol. Nutr. |volume=59 Suppl 1 |issue= |pages=S9–S11 |year=2014 |pmid=24979198 |doi=10.1097/01.mpg.0000450394.30780.ea |url=}}</ref>
-{| class="wikitable"
+{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
-! rowspan="3" |
+! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms frequency
-! colspan="8" |Symtpms
+! colspan="8" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
 |-
-!Intestinal
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Intestinal
-! colspan="7" |Extra-intestinal
+! colspan="7" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Extra-intestinal
 |-
-!
+! align="center" style="background:#DCDCDC;" |Hematologic
-!Hematologic
+! align="center" style="background:#DCDCDC;" |Dermatologic
-!Dermatologic
+! align="center" style="background:#DCDCDC;" |Neurologic
-!Neurologic
+! align="center" style="background:#DCDCDC;" |Musculoskeletal
-!Musculoskeletal
+! align="center" style="background:#DCDCDC;" |Hepatic
-!Hepatic
+! align="center" style="background:#DCDCDC;" |Renal
-!Renal
+! align="center" style="background:#DCDCDC;" |Cardiac
-!Cardiac
 |-
-|Common
+| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Common
 Symptoms
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Recurrent abdominal pain
+* [[Recurrent abdominal pain]]
-* Diarrhea
+* [[Diarrhea]]
-* Vomiting
+* [[Vomiting]]
-* Occult blood in stool
+* [[Occult blood|Occult blood in stool]]
-* Steatorrhea
+* [[Steatorrhea]]
-* Weight loss
+* [[Weight loss]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Bruising
+* [[Bruising]]
-* Fatigue
+* [[Fatigue]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Glossitis
+* [[Glossitis]]
-* Angular cheilosis
+* [[Cheilosis|Angular cheilosis]]
-* Lichen planus
+* [[Lichen planus]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Dementia
+* [[Dementia]]
-* Depression
+* [[Depression]]
-* Altered gait
+* [[Gait|Altered gait]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Back pain
+* [[Back pain]]
-* Flank tenderness
+* [[Flank pain|Flank tenderness]]
-|<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|<nowiki>-</nowiki>
+* [[Hepatosplenomegaly]]
-|<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
 |-
-|Less common
+| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Less common
 symptoms
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Constipation
+* [[Constipation]]
-* Flatulence
+* [[Flatulence]]
-* Secondary lactose intolerance
+* Secondary [[lactose intolerance]]
-* Dyspepsia
+* [[Dyspepsia]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Bleeding
+* [[Bleeding]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Blisters
+* [[Blisters]]
-* Maculopapular rash
+* [[Maculopapular rash]]
-* Pustules
+* [[Pustules]]
-* Alopecia
+* [[Alopecia]]
-* Lichen planus
 * Erosive buccal lesions
-* Eczema
+* [[Eczema]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Ataxia
+* [[Ataxia]]
-* Seizures
+* [[Seizure|Seizures]]
-|
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Arthralgia
+* [[Arthralgia]]
-* Joint tenderness
+* [[Deformities]]
-* Deformities
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|
+* [[Ascites]]
-* Ascites
+* [[Jaundice]]
-* Jaundice
+* [[Gynecomastia]]
-* Gynecomastia
+* [[Spider angioma]]
-* Spider angioma in end-stage liver disease
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|
+* [[Hematuria]]
-* Hematuria
+* [[Dysuria]]
-* Dysuria
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-|
+* [[Chest pain]]
-* Chest pain
+* [[Fatigue]]
-* Fatigue
+* [[Shortness of breath]]
-* Shortness of breath
+* [[Edema]]
-* Edema
 |}
-*:*
+In children gastrointestinal symptoms predominate than extra-intestinal symptoms in celiac disease. Symptoms include:<ref name="pmid8338991">{{cite journal |vauthors=Bottaro G, Failla P, Rotolo N, Sanfilippo G, Azzaro F, Spina M, Patane R |title=Changes in coeliac disease behaviour over the years |journal=Acta Paediatr. |volume=82 |issue=6-7 |pages=566–8 |year=1993 |pmid=8338991 |doi= |url=}}</ref><ref name="pmid16322131">{{cite journal |vauthors=Rashid M, Cranney A, Zarkadas M, Graham ID, Switzer C, Case S, Molloy M, Warren RE, Burrows V, Butzner JD |title=Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children |journal=Pediatrics |volume=116 |issue=6 |pages=e754–9 |year=2005 |pmid=16322131 |doi=10.1542/peds.2005-0904 |url=}}</ref><ref name="pmid15321874">{{cite journal |vauthors=van Rijn JC, Grote FK, Oostdijk W, Wit JM |title=Short stature and the probability of coeliac disease, in the absence of gastrointestinal symptoms |journal=Arch. Dis. Child. |volume=89 |issue=9 |pages=882–3 |year=2004 |pmid=15321874 |pmc=1763207 |doi=10.1136/adc.2004.057851 |url=}}</ref>
+===Common symptoms of celiac disease in children===
+*[[Abdominal pain]]
+*[[Weight loss]]
+*[[Diarrhea]]
+*[[Failure to thrive]]
+===Less common symptoms of celiac disease in children===
+*[[Anorexia]]
+*[[Abdominal distention]]
+*[[Vomiting]]
+*[[Bloating]]
+*[[Growth failure]]
+*[[Irritability]]
+*[[Fatigue]]
+*Irregular [[bowel]] habits
 ==References==
 {{reflist|2}}
+{{WH}}
+{{WS}}
 [[Category:Gastroenterology]]
-[[Category:Primary care]]
 [[Category:Rheumatology]]
 [[Category:Autoimmune diseases]]
-[[Category:Gastroenterology]]
 [[Category:Genetic disorders]]
 [[Category:Malnutrition]]
 [[Category:Pediatrics]]
 [[Category:Dermatology]]
-[[Category:Primary care]]
 [[Category:Up-To-Date]]
-{{WH}}
-{{WS}}