Celiac disease history and symptoms

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

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:

• 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

Celiac crisis

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

The following table summarizes the symptoms of celiac disease in adults.

	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