I would like to add the following highlights to the excellent review
by Andrew D Hopper, et al.
Among atypical symptoms and presentations of celiac disease are anorexia,
nausea, vomiting, severe constipation and failure to thrive.
Epilepsy, and headache could be among atypical neuropsychiatric symptoms.
Ataxia may occur as a result of an immune-mediated process in the
cerebellum.
Dental enamel defects are also more common among children and adults with
celiac disease and suspected to be
immunologically mediated.
About 25 percent of adults with celiac disease have arthritis
Menstrual irregularities, recurrent miscarriage, and infertility are among
other atypical presentations in women.
Celiac disease may be associated with mild chronic elevation in serum
aminotransferase levels.
All patients with chronic refractory fatigue must be screened for celiac
disease. Nutritional deficiencies are usually the underlying cause,
especially vitamin D, B12 and iron deficiency. Lack of vitamin A may cause
poor night visison.
HLA typing for DQ2 and DQ8 may have a diagnostic value in individuals with
equivocal small bowel biopsy since celiac disease is unlikely if this
genetic test is negative.
1. Nelsen DA Jr.
Gluten-sensitive enteropathy (celiac disease): more common than
you think.
Am Fam Physician. 2002;66(12):2259-66.
2. Boscolo S, Sarich A, Lorenzon A, et al
Gluten ataxia: passive transfer in a mouse model.
Ann N Y Acad Sci. 2007;1107:319-28.
3. Hadithi M, von Blomberg BM, Crusius JB, et al
Accuracy of serologic tests and HLA-DQ typing for diagnosing
celiac disease.
Ann Intern Med. 2007 Sep;147(5):294-302.
4. González-Abraldes J, Sánchez-Fueyo A, Bessa Xet al
Persistent hypertransaminasemia as the presenting feature of
celiac disease.
Am J Gastroenterol. 1999;94(4):1095-7.
5. Ciacci C, Cirillo M, Auriemma G, Di Dato G, et al
Celiac disease and pregnancy outcome.
Am J Gastroenterol. 1996;91(4):718-22.
6. Smecuol E, Mauriño E, Vazquez H, Pedreira S, et al
Gynaecological and obstetric disorders in coeliac disease:
frequent clinical onset during
pregnancy or the puerperium.
Eur J Gastroenterol Hepatol. 1996 Jan;8(1):63-89.
7. Djuric Z, Kamenov B, Kati
Celiac disease manifested by polyneuropathy and swollen ankles.
World J Gastroenterol. 2007;13(18):2636-8.
8. Cárdenas A, Kelly CP.
Celiac sprue.
Semin Gastrointest Dis. 2002 Oct;13(4):2
Competing interests:
None declared
Competing interests:
No competing interests
15 September 2007
Shirwan A. Mirza, MD, FACP, FACE
Chairman: Department of Medicine
Auburn Memorial Hospital, Auburn, New York, 13021 USA
Rapid Response:
Celiac Disease: The great imitator
I would like to add the following highlights to the excellent review
by Andrew D Hopper, et al.
Among atypical symptoms and presentations of celiac disease are anorexia,
nausea, vomiting, severe constipation and failure to thrive.
Epilepsy, and headache could be among atypical neuropsychiatric symptoms.
Ataxia may occur as a result of an immune-mediated process in the
cerebellum.
Dental enamel defects are also more common among children and adults with
celiac disease and suspected to be
immunologically mediated.
About 25 percent of adults with celiac disease have arthritis
Menstrual irregularities, recurrent miscarriage, and infertility are among
other atypical presentations in women.
Celiac disease may be associated with mild chronic elevation in serum
aminotransferase levels.
All patients with chronic refractory fatigue must be screened for celiac
disease. Nutritional deficiencies are usually the underlying cause,
especially vitamin D, B12 and iron deficiency. Lack of vitamin A may cause
poor night visison.
HLA typing for DQ2 and DQ8 may have a diagnostic value in individuals with
equivocal small bowel biopsy since celiac disease is unlikely if this
genetic test is negative.
1. Nelsen DA Jr.
Gluten-sensitive enteropathy (celiac disease): more common than
you think.
Am Fam Physician. 2002;66(12):2259-66.
2. Boscolo S, Sarich A, Lorenzon A, et al
Gluten ataxia: passive transfer in a mouse model.
Ann N Y Acad Sci. 2007;1107:319-28.
3. Hadithi M, von Blomberg BM, Crusius JB, et al
Accuracy of serologic tests and HLA-DQ typing for diagnosing
celiac disease.
Ann Intern Med. 2007 Sep;147(5):294-302.
4. González-Abraldes J, Sánchez-Fueyo A, Bessa Xet al
Persistent hypertransaminasemia as the presenting feature of
celiac disease.
Am J Gastroenterol. 1999;94(4):1095-7.
5. Ciacci C, Cirillo M, Auriemma G, Di Dato G, et al
Celiac disease and pregnancy outcome.
Am J Gastroenterol. 1996;91(4):718-22.
6. Smecuol E, Mauriño E, Vazquez H, Pedreira S, et al
Gynaecological and obstetric disorders in coeliac disease:
frequent clinical onset during
pregnancy or the puerperium.
Eur J Gastroenterol Hepatol. 1996 Jan;8(1):63-89.
7. Djuric Z, Kamenov B, Kati
Celiac disease manifested by polyneuropathy and swollen ankles.
World J Gastroenterol. 2007;13(18):2636-8.
8. Cárdenas A, Kelly CP.
Celiac sprue.
Semin Gastrointest Dis. 2002 Oct;13(4):2
Competing interests:
None declared
Competing interests: No competing interests