Celiac disease history and symptoms: Difference between revisions

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{| class="wikitable"
{| class="wikitable"
! rowspan="3" |
! rowspan="3" |
! colspan="9" |Symtpms
! colspan="8" |Symtpms
|-
|-
!Intestinal
!Intestinal
! colspan="8" |Extra-intestinal
! colspan="7" |Extra-intestinal
|-
|-
!
!
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!Dermatologic
!Dermatologic
!Neurologic
!Neurologic
!Skeletal
!Musculoskeletal
!Hepatic
!Hepatic
!Joint
!Renal
!Renal
!Cardiac
!Cardiac
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* Altered gait
* Altered gait
|
|
* Frequent fractures
* Back pain
* Growth retardation
* Flank tenderness
* Short stature
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|
|
|-
|-
|Less common
|Less common
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* Seizures
* Seizures
|
|
* Arthralgia
* Joint tenderness
* Deformities
|
|
* Ascites
* Ascites
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* Spider angioma in end-stage liver disease
* Spider angioma in end-stage liver disease
|
|
* Arthralgia
* Joint tenderness
* Deformities
|
* Back pain
* Flank tenderness
* Hematuria
* Hematuria
* Dysuria
* Dysuria
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* Edema
* Edema
|}
|}
* May be asymptomatic
*:*  
* Vague [[abdominal pain]]
* [[Diarrhea]]
* [[Weight loss]]
* [[Malabsorption]] / [[steatorrhea]]
*:* ''Symptoms and pathologic changes resolve with gluten-free diet''
 
In majority of cases diagnosis can be made reliably with blood testing, but the "gold standard" is still small bowel intestinal biopsy (obtained via EGD). Ideally, a small bowel biopsy should be taken while the patient is on a gluten diet and then checked against a follow-up biopsy after 12 weeks on a gluten-free diet. IgA anti-endomysial antibody (EmA) is at least 99% specific, and about 93% sensitive, but some studies show it to be nearly 100% specific and sensitive. Tissue anti-transglutaminase (tTG) antibody is similarly accurate. Total serum IgA is usually normal, but may be low to undetectable in a small percentage patients.  If total IgA is very low, EmA and tTG will not be accurate and a small bowel biopsy should be considered. IgA anti-gliadin antibody (AGA) is more useful as a screening test, and neither anti-gliadin IgA or IgG antibodies are as specific or sensitive as anti-endomysial antibodies or anti-transglutaminase antibodies.
 
Classic symptoms of coeliac disease include [[diarrhoea]], [[weight loss]] (or stunted growth in children), and [[fatigue (physical)|fatigue]], but while coeliac disease is primarily a bowel disease, bowel symptoms may also be limited or even absent. Some patients are diagnosed with symptoms related to the decreased absorption of nutrients or with various symptoms which, although statistically linked, have no clear relationship with the malfunctioning bowel. Given this wide range of possible symptoms, the classic triad is no longer a requirement for diagnosis.
 
Children between 9 and 24 months tend to present with bowel symptoms and growth problems shortly after first exposure to gluten-containing products. Older children may have more malabsorption-related problems and psychosocial problems, while adults generally have malabsorptive problems.<ref name="Ciclitira">{{cite web | first = P | last = Ciclitira  | year= 2002 | url = http://www.bsg.org.uk/bsgdisp1.php?id=c9c5177d2b91e3228066 | title = Interim Guidelines for the Management of Patients with Coeliac Disease | publisher = British Society of Gastroenterology | accessdate = 2007-03-07}}</ref> Many adults with subtle disease only have fatigue or [[anaemia]].
 
* Behavioural changes
* Fatigue, malaise
* Growth delay
* [[Weight loss]] (explained and unexplained)
 
As a summary:
* [[Abdominal pain]]
* [[Anorexia]]
* [[Diarrhea]]
* Flatulence, distention
* [[Hepatic disease]]
* [[Hypoglycemia]]
* [[Malabsorbtion]]
* [[Steatorrhea]] and greasy, bulky stools


==References==
==References==

Revision as of 18:33, 12 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

History and Symptoms

  • The majority of patients with [disease name] are asymptomatic.

OR

  • The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
  • Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. 

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

Common Symptoms

Common symptoms of Celiac disease include:

  • Gastrointestinal manifestations:
    • Recurrent abdominal pain (90% of patients)
    • Diarrhea (50%)
    • Vomiting (53%)
    • Occult blood in stool (25%-45%)
    • Steatorrhea (40%)
    • Constipation (10%)
    • Bloating or abdominal distention
    • Excessive flatulence
    • Secondary lactose intolerance
    • Anorexia
    • Dyspepsia
    • Nutrient and mineral deficiencies
    • Weight loss (71%)
    • Bone fractures (70%); caused by calcium and/or vitamin D deficiencies
    • Iron deficiency anemia (46%); results from iron malabsorption
    • Megaloblastic anemia (8%-41%); results from folate or vitamin B12 malabsorption
    • Recurrent aphthous mouth ulcers (10%-40%); results from vitamin B deficiency
    • Bruising (11%); results from vitamin K deficiency
    • Edema; results from hypoproteinemia
    • Tetany; seen in severe cases of hypocalcemia
    • Enamel hypoplasia; results from calcium deficiency
    • Impaired growth (70%)
    • Short stature (8%-10%)
    • Rickets (2%-8%)
    • Juvenile chronic arthritis (3%)
    • Failure to thrive
    • Delayed eruption of teeth
    • Pubertal delay
    • Delayed onset of menarche
    • Hypotonia
    • Poor appetite
    • Irritability

Less Common symptoms

Celiac crisis

  • Rare
  • Seen in children younger than 2 years of age
  • Life-threatening condition characterized by
    • Severe hypoproteinemia
    • Edema
    • Acidosis
    • Decreased intravascular volume

Less Common Symptoms

Less common symptoms of [disease name] include

  • [Symptom 1]
  • [Symptom 2]
  • [Symptom 3]
Symtpms
Intestinal Extra-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
 - - -
Less common

symptoms

  • Constipation 
  • Flatulence
  • Secondary lactose intolerance
  • Dyspepsia
  • Bleeding
  • Blisters
  • Maculopapular rash
  • Pustules
  • Alopecia
  • Lichen planus
  • Erosive buccal lesions
  • Eczema
  • Ataxia
  • Seizures
  • Arthralgia
  • Joint tenderness
  • Deformities
  • Ascites
  • Jaundice
  • Gynecomastia
  • Spider angioma in end-stage liver disease
  • Hematuria
  • Dysuria
  • Chest pain
  • Fatigue
  • Shortness of breath
  • Edema

References

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

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