EXTRAINTESTINAL MANIFESTATIONS OF CELIAC DISEASE 
Dermatitis herpetiformis:gift_heart:
A blistering skin rash.
elbows, knees, and buttocks.
The rash and mucosal morphology improve on a gluten-free diet.
Dermatitis herpetiformis is a rare occurrence in childhood and is described almost exclusively in teenagers and adults.
Dental enamel hypoplasia:gift_heart:
involve mostly the permanent dentition.
although they have been described also in deciduous teeth.
These changes may be the only presenting manifestation of celiac disease.
Aphthous ulcers:gift_heart:
Can be present in children and in adults with celiac disease.
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.
these ulcers often regress once the patients are on a gluten-free diet.
Delayed tooth eruption:gift_heart:
This has been reported in up to 27% of patients with celiac disease.
This is a nonspecific sign, possibly related to malnutrition.
In conjunction with the rest of the oral examination could raise the suspicion of the dental clinician about the possibility of celiac disease.
Iron-deficiency anemia:gift_heart:
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.
In children, iron deficiency with or without anemia is very common too, but seldom it is seen as the only presenting sign.
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.
In addition to anemia, a number of less common hematologic manifestations can be seen, including hyposplenism, thrombocytosis, and selective IgA deficiency.
Short stature and delayed puberty:gift_heart:
Short stature may be the only manifestation of celiac disease.
10% of children with idiopathic short stature may have celiac disease that can be detected on serologic testing.
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.
Adolescent girls with untreated celiac disease may have delayed onset of menarche.
Chronic hepatitis and hypertransaminasemia:gift_heart:
Patients with untreated celiac disease commonly have elevated transaminase levels (ALT) (AST).
As many as 9% of patients with elevated transaminase levels of unclear etiology may have silent celiac disease.
Liver biopsy findings in these patients reveal nonspecific reactive hepatitis.
In most cases, liver enzymes normalize on a gluten-free diet.
Arthritis and arthralgia:gift_heart:
Arthritis can be a common extraintestinal manifestation of adults with celiac disease, including those on a gluten-free diet.
As many as 3% of children with juvenile chronic arthritis may have celiac disease.
Osteopenia and osteoporosis:gift_heart:
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.
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.
However, the response to the diet can be much less marked in adults.
Neurological problems:gift_heart:
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.
The association with cerebellar ataxia is well described in adults; the term gluten-induced ataxia has been proposed.
Psychiatric disorders:gift_heart:
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:
no evidence has been conclusive:raised_back_of_hand:
However, celiac disease can be associated with some psychiatric disorders, such as depression and anxiety.
These conditions can be severe and usually respond to a gluten-free diet.
((MEDSCAPE))