Extraintestinal manifestations of celiac disease


:gift_heart:Dermatitis herpetiformis​:gift_heart:

:point_right:A blistering skin rash.
:point_right:elbows, knees, and buttocks.
:point_right:The rash and mucosal morphology improve on a gluten-free diet.

:point_right:Dermatitis herpetiformis is a rare occurrence in childhood and is described almost exclusively in teenagers and adults.

:gift_heart:Dental enamel hypoplasia​:gift_heart:

:point_right: involve mostly the permanent dentition.

:point_right:although they have been described also in deciduous teeth.

:point_right: These changes may be the only presenting manifestation of celiac disease.

:gift_heart:Aphthous ulcers​:gift_heart:

:point_right:Can be present in children and in adults with celiac disease.

:point_right:Oral ulcers are neither characteristic nor specific for celiac disease since aphthous ulcers can also be associated with other medical conditions such as inflammatory bowel disease and Behçet disease.

:point_right:these ulcers often regress once the patients are on a gluten-free diet.

:gift_heart:Delayed tooth eruption​:gift_heart:

:point_right:This has been reported in up to 27% of patients with celiac disease.

:point_right:This is a nonspecific sign, possibly related to malnutrition.

:point_right:In conjunction with the rest of the oral examination could raise the suspicion of the dental clinician about the possibility of celiac disease.

:gift_heart:Iron-deficiency anemia​:gift_heart:

:point_right:In several studies, iron-deficiency anemia that is resistant to oral iron supplementation is reportedly the most common extraintestinal manifestation of celiac disease in adults.

:point_right: In children, iron deficiency with or without anemia is very common too, but seldom it is seen as the only presenting sign.

:point_right:Anemia can only be the result of folate, vitamin B-12 deficiency, and it may also coexist with anemia of chronic disease as a result of the chronic intestinal inflammation.

:point_right: In addition to anemia, a number of less common hematologic manifestations can be seen, including hyposplenism, thrombocytosis, and selective IgA deficiency.

:gift_heart:Short stature and delayed puberty​:gift_heart:

:point_right:Short stature may be the only manifestation of celiac disease.

:point_right:10% of children with idiopathic short stature may have celiac disease that can be detected on serologic testing.

:point_right:Some patients with short stature also have impaired growth hormone production following provocative stimulation testing; this production returns to normal when the patient is put on a gluten-free diet.

:point_right: Adolescent girls with untreated celiac disease may have delayed onset of menarche.

:gift_heart:Chronic hepatitis and hypertransaminasemia​:gift_heart:

:point_right: Patients with untreated celiac disease commonly have elevated transaminase levels (ALT) (AST).

:point_right: As many as 9% of patients with elevated transaminase levels of unclear etiology may have silent celiac disease.

:point_right:Liver biopsy findings in these patients reveal nonspecific reactive hepatitis.

:point_right:In most cases, liver enzymes normalize on a gluten-free diet.

:gift_heart:Arthritis and arthralgia​:gift_heart:

:point_right:Arthritis can be a common extraintestinal manifestation of adults with celiac disease, including those on a gluten-free diet.

:point_right:As many as 3% of children with juvenile chronic arthritis may have celiac disease.

:gift_heart:Osteopenia and osteoporosis​:gift_heart:

:point_right:Approximately 50% of children and 75% of adults have a low bone mineral density at the time of diagnosis; this low density reaches severe degrees, including osteoporosis.

:point_right: Bone mineral density improves in most patients on gluten-free diet and returns to normal as soon as 1 year after starting the diet in children.

:point_right:However, the response to the diet can be much less marked in adults.

:gift_heart:Neurological problems​:gift_heart:

:point_right:Celiac disease may cause occipital calcifications and intractable epilepsy​:point_right: these patients can be resistant to antiseizure medicines but can benefit from a gluten-free diet if it is started soon after onset of seizures.

:point_right:The association with cerebellar ataxia is well described in adults; the term gluten-induced ataxia has been proposed.

:gift_heart:Psychiatric disorders​:gift_heart:

:point_right:Although a large number of behavioral problems and disorders (eg, autism, attention deficit hyperactivity disorder) have been thought to be caused by celiac disease​:raised_back_of_hand::raised_back_of_hand: no evidence has been conclusive​:raised_back_of_hand::raised_back_of_hand:

:point_right:However, celiac disease can be associated with some psychiatric disorders, such as depression and anxiety.

:point_right:These conditions can be severe and usually respond to a gluten-free diet.