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{{Celiac disease}}
{{Celiac disease}}
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{{CMG}} {{AE}} {{MIR}}
==Overview==
The [[symptoms]] of celiac disease usually develop in the first decade of life, and start with features suggestive of [[malabsorption]] such as [[abdominal pain]] and [[Abdominal distension|distension]], [[diarrhea]], [[malnutrition]], and [[failure to thrive]] within the first few years of life. The classic [[malabsorption]] manifestation of disease is just the tip of the iceberg, and other more specific manifestations are invisible below the waterline. Natural history of celiac disease is not completely understood but if left untreated it may result in serious complications, such as [[malignancy]]. Complications of celiac disease may include [[vitamin deficiencies]], essential [[nutrient]] deficiencies, [[Tooth enamel|enamel]] [[hypoplasia]], [[neurological]] abnormalities, [[gastrointestinal]] [[malignancies]], [[hyposplenism]], [[Ulcer|ulcerative]] [[jejunitis]], and [[infertility]]. The [[prognosis]] may vary depending upon the extent of the celiac disease at the time of diagnosis and also the extent of complications and [[dietary]] deficiencies. However, the [[prognosis]] is generally regarded as good. The presence of [[Gastrointestinal tract|gastrointestinal]] [[malignancies]] is associated with a particularly poor [[prognosis]] among patients with celiac disease.


==Overview==
==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==


===Natural History===
===Natural History===
The [[symptoms]] of celiac disease usually develop in the firs decade of life, and start with symptoms suggestive of [[malabsorption]] such as [[pain]] and [[distension]], [[Diarrhea|diarrhea,]] [[malnutrition]], and [[failure to thrive]] within the first few years of life. These are classical celiac disease findings also known as “celiac disease iceberg” manifestations. Clinical presentations in celiac disease have been described as an iceberg model. Based on the iceberg model of celiac disease, the classic [[malabsorption]] manifestation of disease is just the tip of the iceberg, and other more specific manifestations are invisible below the waterline. According to iceberg model of celiac disease, the traditional method of diagnosing celiac disease based on [[malnutrition]] manifestations is unreliable due to different [[disease]] variation with more subtle manifestations that may be unrecognized.  
The [[symptoms]] of celiac disease usually develop in the firs decade of life, and start with symptoms suggestive of [[malabsorption]] such as [[pain]] and [[distension]], [[Diarrhea|diarrhea,]] [[malnutrition]], and [[failure to thrive]] within the first few years of life. These are classical celiac disease findings also known as “celiac disease iceberg” manifestations. Clinical presentations in celiac disease have been described as an iceberg model. Based on the iceberg model of celiac disease, the classic [[malabsorption]] manifestation of disease is just the tip of the iceberg, and other more specific manifestations are invisible below the waterline. According to iceberg model of celiac disease, the traditional method of diagnosing celiac disease based on [[malnutrition]] manifestations is unreliable due to different [[disease]] variation with more subtle manifestations that may be unrecognized. <ref name="pmid20868314">{{cite journal |vauthors=Catassi C, Kryszak D, Bhatti B, Sturgeon C, Helzlsouer K, Clipp SL, Gelfond D, Puppa E, Sferruzza A, Fasano A |title=Natural history of celiac disease autoimmunity in a USA cohort followed since 1974 |journal=Ann. Med. |volume=42 |issue=7 |pages=530–8 |year=2010 |pmid=20868314 |doi=10.3109/07853890.2010.514285 |url=}}</ref>


Most people with either diagnosed or undiagnosed celiac disease have only minor [[Symptom|symptoms]] that are more inconvenient than life threatening. The few data available regarding quality of life of patients with celiac disease suggest that health‐related quality of life and psychological general well‐being are poor in undiagnosed patients, and improve with treatment in men but not significantly in women.<ref name="pmid11197241">{{cite journal |vauthors=Green PHR, Stavropoulos SN, Panagi SG, Goldstein SL, Mcmahon DJ, Absan H, Neugut AI |title=Characteristics of adult celiac disease in the USA: results of a national survey |journal=Am. J. Gastroenterol. |volume=96 |issue=1 |pages=126–31 |year=2001 |pmid=11197241 |doi=10.1111/j.1572-0241.2001.03462.x |url=}}</ref> The frequency of [[psychiatric disorders]] are also high among celiac disease patients, with a [[questionnaire]] study reported a mean duration of [[depression]] and [[anxiety]] symptoms for 11 years before the diagnosis of coeliac disease was made that was followed by an improve of 77% after treatment. A high prevalence of [[depression]] was well documented in patients with coeliac disease.<ref name="pmid9548616">{{cite journal |vauthors=Ciacci C, Iavarone A, Mazzacca G, De Rosa A |title=Depressive symptoms in adult coeliac disease |journal=Scand. J. Gastroenterol. |volume=33 |issue=3 |pages=247–50 |year=1998 |pmid=9548616 |doi= |url=}}</ref>
Most people with either diagnosed or undiagnosed celiac disease have only minor [[Symptom|symptoms]] that are more inconvenient than life threatening. The few data available regarding [[quality of life]] of patients with celiac disease suggest that health‐related quality of life and [[psychological]] general well‐being are poor in undiagnosed patients, and improve with treatment in men but not significantly in women.<ref name="pmid11197241">{{cite journal |vauthors=Green PHR, Stavropoulos SN, Panagi SG, Goldstein SL, Mcmahon DJ, Absan H, Neugut AI |title=Characteristics of adult celiac disease in the USA: results of a national survey |journal=Am. J. Gastroenterol. |volume=96 |issue=1 |pages=126–31 |year=2001 |pmid=11197241 |doi=10.1111/j.1572-0241.2001.03462.x |url=}}</ref> The frequency of [[psychiatric disorders]] are also high among celiac disease patients, and the severity of [[depression]] is associated with the duration of disease left without treatment. A [[questionnaire]] study in USA reported a mean duration of [[depression]] and [[anxiety]] symptoms for 11 years before the diagnosis of celiac disease. The mentioned [[depression]] was reported to get improved in 77% of cases after treatment. A high prevalence of [[depression]] was well documented in patients with celiac disease.<ref name="pmid9548616">{{cite journal |vauthors=Ciacci C, Iavarone A, Mazzacca G, De Rosa A |title=Depressive symptoms in adult coeliac disease |journal=Scand. J. Gastroenterol. |volume=33 |issue=3 |pages=247–50 |year=1998 |pmid=9548616 |doi= |url=}}</ref><ref name="pmid20868314">{{cite journal |vauthors=Catassi C, Kryszak D, Bhatti B, Sturgeon C, Helzlsouer K, Clipp SL, Gelfond D, Puppa E, Sferruzza A, Fasano A |title=Natural history of celiac disease autoimmunity in a USA cohort followed since 1974 |journal=Ann. Med. |volume=42 |issue=7 |pages=530–8 |year=2010 |pmid=20868314 |doi=10.3109/07853890.2010.514285 |url=}}</ref><ref name="pmid25922673">{{cite journal |vauthors=Zingone F, Swift GL, Card TR, Sanders DS, Ludvigsson JF, Bai JC |title=Psychological morbidity of celiac disease: A review of the literature |journal=United European Gastroenterol J |volume=3 |issue=2 |pages=136–45 |year=2015 |pmid=25922673 |pmc=4406898 |doi=10.1177/2050640614560786 |url=}}</ref>


The adult patients with celiac disease are at higher risk of:
The adult patients with celiac disease are at higher risk of:<ref name="pmid25922673">{{cite journal |vauthors=Zingone F, Swift GL, Card TR, Sanders DS, Ludvigsson JF, Bai JC |title=Psychological morbidity of celiac disease: A review of the literature |journal=United European Gastroenterol J |volume=3 |issue=2 |pages=136–45 |year=2015 |pmid=25922673 |pmc=4406898 |doi=10.1177/2050640614560786 |url=}}</ref>
* Mortality from [[malignancy]] especially [[lymphomas]] in patients aged 45-65
* Mortality from [[malignancy]] especially [[lymphomas]] in patients aged 45-65
* [[Suicide]]
* [[Suicide]]
* [[Diabetes]]  
* [[Diabetes]]  
* [[Inflammatory bowel disease]]
* [[Inflammatory bowel disease]]
There are different unknown variations of celiac disease which include:
*[[Asymptomatic]]
*Silent: Asymptomatic and no [[disease]] manifestation including evident [[malabsorption]]
*Potential: Positive celiac-specific [[serology]] with normal [[histology]]
[[Natural history of disease|Natural history]] of these celiac disease variations is not completely understood. Particularly, the long-term risk of [[complications]] in patients who are asymptomatic or silent is not available. Undiagnosed celiac disease has been shown to be associated with a nearly 4-fold increased risk of death compared with asymptomatic patients whom are negative for serologic evidence of celiac disease.


As the risk of malignancy in celiac disease exist, it is recommended to asymptomatic and silent patients should patients to comply with a gluten-free diet. The majority of patients with celiac disease respond to a gluten-free diet. The most common reasons for a lack of response are poor compliance or inadvertent gluten ingestion. Thus, we suggest a meticulous dietary history should be obtained, and dietary counselling pursued with an experienced dietitian in patients who continue to have symptoms or persistent histologic abnormalities, or in those in whom serum antibody titers have not declined.
[[Natural history of disease|Natural history]] of celiac disease variations is not completely understood. Particularly, the long-term risk of [[complications]] in patients who are asymptomatic or silent is not available. Undiagnosed celiac disease has been shown to be associated with a nearly 4-fold increased risk of death compared with asymptomatic patients whom are negative for [[Serology|serologic]] evidence of celiac disease.
 
As the risk of [[malignancy]] in celiac disease exist, it is recommended to asymptomatic and silent patients should patients to comply with a [[gluten-free diet]]. The majority of patients with celiac disease respond to a [[gluten-free diet]]. The most common reason for a lack of response are poor compliance or inadvertent gluten ingestion.
 
===Complications===
===Complications===
The most important complications of celiac disease are listed in the table below:<ref name="pmid20431755">{{cite journal |vauthors=Freeman HJ |title=Adult celiac disease and its malignant complications |journal=Gut Liver |volume=3 |issue=4 |pages=237–46 |year=2009 |pmid=20431755 |pmc=2852736 |doi=10.5009/gnl.2009.3.4.237 |url=}}</ref><ref name="pmid23155333">{{cite journal |vauthors=Gujral N, Freeman HJ, Thomson AB |title=Celiac disease: prevalence, diagnosis, pathogenesis and treatment |journal=World J. Gastroenterol. |volume=18 |issue=42 |pages=6036–59 |year=2012 |pmid=23155333 |pmc=3496881 |doi=10.3748/wjg.v18.i42.6036 |url=}}</ref><ref name="pmid15610706">{{cite journal |vauthors=Chin RL, Latov N |title=Peripheral Neuropathy and Celiac Disease |journal=Curr Treat Options Neurol |volume=7 |issue=1 |pages=43–48 |year=2005 |pmid=15610706 |doi= |url=}}</ref><ref name="pmid21682114">{{cite journal |vauthors=Choi JM, Lebwohl B, Wang J, Lee SK, Murray JA, Sauer MV, Green PH |title=Increased prevalence of celiac disease in patients with unexplained infertility in the United States |journal=J Reprod Med |volume=56 |issue=5-6 |pages=199–203 |year=2011 |pmid=21682114 |pmc=3122153 |doi= |url=}}</ref><ref name="pmid19340898">{{cite journal |vauthors=Freeman HJ |title=Malignancy in adult celiac disease |journal=World J. Gastroenterol. |volume=15 |issue=13 |pages=1581–3 |year=2009 |pmid=19340898 |pmc=2669940 |doi= |url=}}</ref><ref name="pmid23041739">{{cite journal |vauthors=Ghoshal UC, Mehrotra M, Kumar S, Ghoshal U, Krishnani N, Misra A, Aggarwal R, Choudhuri G |title=Spectrum of malabsorption syndrome among adults & factors differentiating celiac disease & tropical malabsorption |journal=Indian J. Med. Res. |volume=136 |issue=3 |pages=451–9 |year=2012 |pmid=23041739 |pmc=3510892 |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>
{| class="wikitable"
{| class="wikitable"
! colspan="2" |Disease
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
!Manifestations
! align="center" style="background:#4479BA; color: #FFFFFF;" |Manifestations
!
|-
|-
| rowspan="3" |Vitamine deficiencies
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Vitamine deficiencies
|Vitamin  K deficiency
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Vitamin  K deficiency]]
|
* Easy bruisability
* Mucosal bleeding
* Splinter hemorrhages
* Melena
* Hematuria
|
|
* Easy [[bruising]]
* [[Mucosal bleeding]]
* [[Splinter hemorrhages]]
* [[Melena]]
* [[Hematuria]]
|-
|-
|[[B12 deficiency|Vitamin B12 deficiency]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[B12 deficiency|Vitamin B12 deficiency]]
|
* Unexplained anemia with macrocytosis
* Pancytopenia
* Hypersegmented neutrophils
* Unexplained neurologic or psychiatric symptoms
** Symmetric paresthesias or numbness and gait problems
** Subacute combined degeneration of the dorsal (posterior) and lateral columns (white matter) of the spinal cord due to demyelination
|
|
* Unexplained [[anemia]] with [[macrocytosis]]
* [[Pancytopenia]]
* Hypersegmented [[neutrophils]]
* Unexplained [[neurologic]] or [[Psychiatric disease|psychiatric symptoms]]
** Symmetric [[paresthesias]] or [[numbness]] and gait problems
** Subacute combined [[degeneration]] of the dorsal (posterior) and [[lateral column]] (white matter) of the spinal cord due to [[demyelination]]
|-
|-
|Vitamin D deficiency
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Vitamin D deficiency]]
| rowspan="2" |
| rowspan="2" |
* secondary hyperparathyroidism:
* Secondary [[hyperparathyroidism]]
** phosphaturia
** [[Phosphaturia]]
** Demineralization of bones
** [[Bone loss|Demineralization of bones]]
** Osteomalacia in adults
** [[Osteomalacia]] in adults
** Rickets and osteomalacia in children
** [[Rickets]] and [[osteomalacia]] in children
* Bone pain and tenderness
* [[Bone pain]] and [[tenderness]]
* Muscle weakness
* [[Muscle weakness]]
* Fracture
* [[Fracture]]
* Difficulty walking
* [[Difficulty walking]]
|
|-
|-
| rowspan="3" |Micronutrient deficiencies
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Micronutrient deficiencies
|[[Calcium deficiency]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Calcium deficiency]]
|
|-
|-
|Iron deficiency
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Iron deficiency]]
|
* anemia with non-specific symptoms include:
** Fatigue
** Weakness and irritability
** Headache
** Veretigo
* Microcytic hypochromic anemia
|
|
* [[Microcytic]] [[hypochromic]] [[anemia]] with non-specific symptoms include:
** [[Fatigue]]
** [[Weakness]] and [[irritability]]
** [[Headache]]
** [[Vertigo]]
|-
|-
|[[Folate deficiency]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Folate deficiency]]
|
* Unexplained anemia with macrocytosis
* Pancytopenia
|
|
* Unexplained [[anemia]] with [[macrocytosis]]
* [[Pancytopenia]]
|-
|-
| colspan="2" |Enamel hypoplasias
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Enamel hypoplasias
|
* In greater than twenty percent of celiac disease cases in children
* Linear hypoplasia on the teeth
|
|
* Occur in greater than twenty percent of celiac disease cases in children
* Linear [[hypoplasia]] on the [[Tooth|teeth]]
|-
|-
| colspan="2" |[[Dermatitis herpetiformis]] 
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Dermatitis herpetiformis]] 
|
|
* cutaneous manifestations of gluten-sensitivity:  
* [[Cutaneous]] manifestations of [[gluten sensitivity]]:  
** Multiple intensely pruritic papules and vesicles that occur in grouped ("herpetiform") arrangements
** Multiple intensely [[Pruritis|pruritic]] [[papules]] and [[vesicles]] that occur in grouped, herpetiform arrangements
** Mainly in The elbows, dorsal forearms, knees, scalp, back, and buttocks
** Mainly in The [[elbows]], dorsal [[Forearm|forearms]], [[Knee|knees]], [[scalp]], [[back]], and [[buttocks]]


* Oral manifestations of gluten-sensitivity:  
* [[Oral]] manifestations of [[gluten sensitivity]]:  
** vesicles, erosions, or erythematous macules on the oral mucosa or tongue
** [[vesicles]], [[Erosion (dental)|erosions]], or [[Erythematous rash|erythematous macules]] on the oral mucosa or [[tongue]]
|
|-
|-
| colspan="2" |Neurological abnormalities
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Neurological disease|Neurological abnormalities]]
|
|
* All more common in children
* More common in children
* Include:
* Include:
** Hypotonia
** [[Hypotonia]]
** Developmental delay
** [[Developmental delay]]
** Learning disorders
** [[Learning disorder|Learning disorders]]
** ADHD
** [[ADHD]]
** Headache
** [[Headache]]
** Cerebellar ataxia
** [[Cerebellar ataxia]]
|
|-
|-
|gastrointestinal malignancies
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gastrointestinal malignancies
|[[Small bowel lymphoma]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Small bowel lymphoma]]
|
* Fever
* Hepatosplenomegaly
* Duodenal mass
* Ascites
|
|
* [[Fever]]
* [[Hepatosplenomegaly]]
* [[Duodenum|Duodenal]] mass
* [[Ascites]]
|-
|-
| colspan="2" |hyposplenism
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hyposplenism]]
|
* Increase risk of sepsis and [[bacteremia]] due to encapsulated pathogens
|
|
* Increase risk of [[sepsis]] and [[bacteremia]] due to encapsulated pathogens:
** [[Pseudomonas aeruginosa]] (especially [[respiratory infections]])
** [[Streptococcus pneumonia]]
** [[Streptococcus, Group B|Streptococcus group B]]
** [[Hemophilus influenza]]
** [[Neisseria meningitidis]]
** [[Escherichia coli]]
** [[Salmonella]] (especially [[osteomyelitis]])
** [[Klebsiella]]
|-
|-
| colspan="2" |Ulcerative jejunitis 
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ulcerative jejunitis 
|
|
* Multiple chronic, benign-appearing ulcers, most frequently in the jejunum
* Multiple chronic, benign-appearing [[ulcers]], most frequently in the [[jejunum]]
* Recurrent symptoms of despite being on a gluten-free diet:
* Recurrent symptoms of despite being on a gluten-free diet:
** Malabsorption
** [[Malabsorption]]
** Lassitude
** [[Lassitude|Fatigue]]
** Anorexia
** [[Anorexia]]
** Weight loss
** [[Weight loss]]
** Fever  
** [[Fever]]
|
|-
|-
| colspan="2" |Infertility
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Infertility]]
|
* The failure of a couple to conceive:
** In women under age 35 after 12 months of frequent intercourse without use of contraception
** In women over age 35, and after six months of frequent intercourse without use of contraception
|
|
* The failure of a couple to [[Conceive a child|conceive]]:
** In women under age 35 after 12 months of frequent intercourse without use of [[contraception]]
** In women over age 35, and after six months of frequent intercourse without use of [[contraception]]
|}
|}


===Prognosis===
===Prognosis===
*Depending on the extent of the celiac disease at the time of diagnosis and also extent of complications and diet complication, the prognosis may vary. However, the prognosis is generally regarded as good.
*Depending on the extent of the celiac disease at the time of diagnosis and also extent of complications and diet complication, the prognosis may vary. However, the prognosis is generally regarded as good.<ref name="pmid21990301">{{cite journal |vauthors=Leffler D |title=Celiac disease diagnosis and management: a 46-year-old woman with anemia |journal=JAMA |volume=306 |issue=14 |pages=1582–92 |year=2011 |pmid=21990301 |pmc=3373262 |doi=10.1001/jama.306.14.1582 |url=}}</ref>
*People with celiac disease are at higher risk of mortality than the general population. Although people with celiac disease had an increased risk of gastrointestinal and lymphoproliferative malignancies compared with the general population, it has been shown that they are in a lower risk of breast or lung cancer.
*People with celiac disease are at higher risk of mortality than the general population. Although people with celiac disease had an increased risk of [[Gastrointestinal Tract Cancer|gastrointestinal]] and [[Lymphoproliferative neoplasm|lymphoproliferative malignancies]] compared with the general population, it has been shown that they are in a lower risk of [[Breast cancer|breast]] or [[lung cancer]].<ref name="pmid21990301">{{cite journal |vauthors=Leffler D |title=Celiac disease diagnosis and management: a 46-year-old woman with anemia |journal=JAMA |volume=306 |issue=14 |pages=1582–92 |year=2011 |pmid=21990301 |pmc=3373262 |doi=10.1001/jama.306.14.1582 |url=}}</ref>
*The presence of gastrointestinal malignancies is associated with a particularly poor prognosis among patients with celiac disease.
*The presence of [[Gastrointestinal tract cancer|gastrointestinal malignancies]] is associated with a particularly poor prognosis among patients with celiac disease.<ref name="pmid21990301">{{cite journal |vauthors=Leffler D |title=Celiac disease diagnosis and management: a 46-year-old woman with anemia |journal=JAMA |volume=306 |issue=14 |pages=1582–92 |year=2011 |pmid=21990301 |pmc=3373262 |doi=10.1001/jama.306.14.1582 |url=}}</ref>


==References==
==References==
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Latest revision as of 20:50, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

The symptoms of celiac disease usually develop in the first decade of life, and start with features suggestive of malabsorption such as abdominal pain and distension, diarrhea, malnutrition, and failure to thrive within the first few years of life. The classic malabsorption manifestation of disease is just the tip of the iceberg, and other more specific manifestations are invisible below the waterline. Natural history of celiac disease is not completely understood but if left untreated it may result in serious complications, such as malignancy. Complications of celiac disease may include vitamin deficiencies, essential nutrient deficiencies, enamel hypoplasia, neurological abnormalities, gastrointestinal malignancies, hyposplenism, ulcerative jejunitis, and infertility. The prognosis may vary depending upon the extent of the celiac disease at the time of diagnosis and also the extent of complications and dietary deficiencies. However, the prognosis is generally regarded as good. The presence of gastrointestinal malignancies is associated with a particularly poor prognosis among patients with celiac disease.

Natural History, Complications, and Prognosis

Natural History

The symptoms of celiac disease usually develop in the firs decade of life, and start with symptoms suggestive of malabsorption such as pain and distension, diarrhea, malnutrition, and failure to thrive within the first few years of life. These are classical celiac disease findings also known as “celiac disease iceberg” manifestations. Clinical presentations in celiac disease have been described as an iceberg model. Based on the iceberg model of celiac disease, the classic malabsorption manifestation of disease is just the tip of the iceberg, and other more specific manifestations are invisible below the waterline. According to iceberg model of celiac disease, the traditional method of diagnosing celiac disease based on malnutrition manifestations is unreliable due to different disease variation with more subtle manifestations that may be unrecognized. [1]

Most people with either diagnosed or undiagnosed celiac disease have only minor symptoms that are more inconvenient than life threatening. The few data available regarding quality of life of patients with celiac disease suggest that health‐related quality of life and psychological general well‐being are poor in undiagnosed patients, and improve with treatment in men but not significantly in women.[2] The frequency of psychiatric disorders are also high among celiac disease patients, and the severity of depression is associated with the duration of disease left without treatment. A questionnaire study in USA reported a mean duration of depression and anxiety symptoms for 11 years before the diagnosis of celiac disease. The mentioned depression was reported to get improved in 77% of cases after treatment. A high prevalence of depression was well documented in patients with celiac disease.[3][1][4]

The adult patients with celiac disease are at higher risk of:[4]

Natural history of celiac disease variations is not completely understood. Particularly, the long-term risk of complications in patients who are asymptomatic or silent is not available. Undiagnosed celiac disease has been shown to be associated with a nearly 4-fold increased risk of death compared with asymptomatic patients whom are negative for serologic evidence of celiac disease.

As the risk of malignancy in celiac disease exist, it is recommended to asymptomatic and silent patients should patients to comply with a gluten-free diet. The majority of patients with celiac disease respond to a gluten-free diet. The most common reason for a lack of response are poor compliance or inadvertent gluten ingestion.

Complications

The most important complications of celiac disease are listed in the table below:[5][6][7][8][9][10][11]

Disease Manifestations
Vitamine deficiencies Vitamin K deficiency
Vitamin B12 deficiency
Vitamin D deficiency
Micronutrient deficiencies Calcium deficiency
Iron deficiency
Folate deficiency
Enamel hypoplasias
  • Occur in greater than twenty percent of celiac disease cases in children
  • Linear hypoplasia on the teeth
Dermatitis herpetiformis 
Neurological abnormalities
Gastrointestinal malignancies Small bowel lymphoma
Hyposplenism
Ulcerative jejunitis 
Infertility
  • The failure of a couple to conceive:
    • In women under age 35 after 12 months of frequent intercourse without use of contraception
    • In women over age 35, and after six months of frequent intercourse without use of contraception

Prognosis

  • Depending on the extent of the celiac disease at the time of diagnosis and also extent of complications and diet complication, the prognosis may vary. However, the prognosis is generally regarded as good.[12]
  • People with celiac disease are at higher risk of mortality than the general population. Although people with celiac disease had an increased risk of gastrointestinal and lymphoproliferative malignancies compared with the general population, it has been shown that they are in a lower risk of breast or lung cancer.[12]
  • The presence of gastrointestinal malignancies is associated with a particularly poor prognosis among patients with celiac disease.[12]

References

  1. ↑ 1.0 1.1 Catassi C, Kryszak D, Bhatti B, Sturgeon C, Helzlsouer K, Clipp SL, Gelfond D, Puppa E, Sferruzza A, Fasano A (2010). "Natural history of celiac disease autoimmunity in a USA cohort followed since 1974". Ann. Med. 42 (7): 530–8. doi:10.3109/07853890.2010.514285. PMID 20868314.
  2. ↑ Green P, Stavropoulos SN, Panagi SG, Goldstein SL, Mcmahon DJ, Absan H, Neugut AI (2001). "Characteristics of adult celiac disease in the USA: results of a national survey". Am. J. Gastroenterol. 96 (1): 126–31. doi:10.1111/j.1572-0241.2001.03462.x. PMID 11197241. Vancouver style error: initials (help)
  3. ↑ Ciacci C, Iavarone A, Mazzacca G, De Rosa A (1998). "Depressive symptoms in adult coeliac disease". Scand. J. Gastroenterol. 33 (3): 247–50. PMID 9548616.
  4. ↑ 4.0 4.1 Zingone F, Swift GL, Card TR, Sanders DS, Ludvigsson JF, Bai JC (2015). "Psychological morbidity of celiac disease: A review of the literature". United European Gastroenterol J. 3 (2): 136–45. doi:10.1177/2050640614560786. PMC 4406898. PMID 25922673.
  5. ↑ Freeman HJ (2009). "Adult celiac disease and its malignant complications". Gut Liver. 3 (4): 237–46. doi:10.5009/gnl.2009.3.4.237. PMC 2852736. PMID 20431755.
  6. ↑ Gujral N, Freeman HJ, Thomson AB (2012). "Celiac disease: prevalence, diagnosis, pathogenesis and treatment". World J. Gastroenterol. 18 (42): 6036–59. doi:10.3748/wjg.v18.i42.6036. PMC 3496881. PMID 23155333.
  7. ↑ Chin RL, Latov N (2005). "Peripheral Neuropathy and Celiac Disease". Curr Treat Options Neurol. 7 (1): 43–48. PMID 15610706.
  8. ↑ Choi JM, Lebwohl B, Wang J, Lee SK, Murray JA, Sauer MV, Green PH (2011). "Increased prevalence of celiac disease in patients with unexplained infertility in the United States". J Reprod Med. 56 (5–6): 199–203. PMC 3122153. PMID 21682114.
  9. ↑ Freeman HJ (2009). "Malignancy in adult celiac disease". World J. Gastroenterol. 15 (13): 1581–3. PMC 2669940. PMID 19340898.
  10. ↑ Ghoshal UC, Mehrotra M, Kumar S, Ghoshal U, Krishnani N, Misra A, Aggarwal R, Choudhuri G (2012). "Spectrum of malabsorption syndrome among adults & factors differentiating celiac disease & tropical malabsorption". Indian J. Med. Res. 136 (3): 451–9. PMC 3510892. PMID 23041739.
  11. ↑ 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.
  12. ↑ 12.0 12.1 12.2 Leffler D (2011). "Celiac disease diagnosis and management: a 46-year-old woman with anemia". JAMA. 306 (14): 1582–92. doi:10.1001/jama.306.14.1582. PMC 3373262. PMID 21990301.

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