Celiac disease history and symptoms
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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 | ||||
|---|---|---|---|---|
| Adults | Children | |||
| Intestinal | Extra-intestinal | Intestinal | Extra-intestinal | |
| Common
Symptoms |
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Hematologic manifestations:
Dermatologic manifestations:
Neurologic manifestations:
Skeletal manifestations
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| Less common
symptoms |
Hematologic manifestations:
Dermatologic manifestations:
Neurologic manifestations:
Hepatic manifestations
Joint manifestations:
Renal manifestiona Cardiac manifestations:
|
|||
- 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, 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.[2] 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
- ↑ Green PH, Cellier C (2007). "Celiac disease". N. Engl. J. Med. 357 (17): 1731–43. doi:10.1056/NEJMra071600. PMID 17960014.
- ↑ Ciclitira, P (2002). "Interim Guidelines for the Management of Patients with Coeliac Disease". British Society of Gastroenterology. Retrieved 2007-03-07.