The article on celiac disease by Roger Jones and Sarah Sleet is well written.[1]
We will do our patients and the health care system a great service if
we put celiac disease on the top of the list of differential diagnoses of
many clinical scenarios.
We all remember that in the medical school we used to call syphilis the
great imitator of neurological disorders.
I believe now celiac disease should assume that title.
I am an endocrinologist and screen for celiac disease likely as frequently
as any gastroenterologist.
Celiac disease is an endocrine cousin:
It causes as much fatigue as hypothyroidism. It causes menstrual
irregularities likely via nutritional deficiencies.It causes miscarriages
(should be thought of in women with recurrent miscarriages), causes
infertility (should be thought of before embarking on costly fertility
treatments), psychiatric problems such as anxiety and depression, poor
memory and concentration via vitamin B12 deficiency or insufficiency.
Celiac disease causes vitamin D deficiency, in itself another disease
mostly missed and it causes severe fatigue, muscle aches and weakness and
tremendous bone pains usually misdiagnosed as fibromyalgia.
Celiac disease should be thought of in investigating osteoporosis with
severe reduction in Z-scores.
Celiac disease causes unexplained elevation in liver enzymes,
including alkaline phosphatase, which could rise partly due to its bone
component due to osteomalacia and vitamin D deficiency.
celiac disease can cause explained seizures and electrolyte imbalances
such as hypocalcemia, when the vitamin D deficiency is severe.
Celiac disease could cause peripheral neuropaty via vitamin B12
deficiency.
Celiac disease can cause skin rash and should be in the differential
diagnosis of such disorder.
Celiac disease is associated with other autoimmune disorders such as type
1 diabetes, and should be in the differential diagnosis of hypoglycemia in
every patient with type 1 diabetes.
Celiac disease can cause low night vision via vitamin A deficiency
and every patient with vitamin A deficiency should be screened.
Patients, especially women with alopecia should be screened for iron and
zinc deficiency, both are nutritional factors in hair growth. Zinc
deficiency can also cause dyguisia, recurrent upper respiratory
infections, and low night vision.
Patients with hypothyroidism whose TSH is always high despite huge doses
of levothyroxine must be screened for celiac disease provided they take
leveothyroxine on an empty stomach without food or coffee or other
medications for at least an hour before breakfast.
Celiac disease could also an underlying cause for elevated
homocysteine and abdominal bacterial overgrowth causing even more
gastrointestinal symptoms such as pain or bloating.
Shirwan Mirza, MD, FACP, FACE
References:
1. Published 19 February 2009, BMJ 2009;338:a3058
Practice
Easily Missed?
Coeliac disease Roger Jones, Wolfson professor of general practice, Sarah Sleet,
chief executive
Rapid Response:
Celiac Disease: The Great Imitator
The article on celiac disease by Roger Jones and Sarah Sleet is well written.[1]
We will do our patients and the health care system a great service if
we put celiac disease on the top of the list of differential diagnoses of
many clinical scenarios.
We all remember that in the medical school we used to call syphilis the
great imitator of neurological disorders.
I believe now celiac disease should assume that title.
I am an endocrinologist and screen for celiac disease likely as frequently
as any gastroenterologist.
Celiac disease is an endocrine cousin:
It causes as much fatigue as hypothyroidism. It causes menstrual
irregularities likely via nutritional deficiencies.It causes miscarriages
(should be thought of in women with recurrent miscarriages), causes
infertility (should be thought of before embarking on costly fertility
treatments), psychiatric problems such as anxiety and depression, poor
memory and concentration via vitamin B12 deficiency or insufficiency.
Celiac disease causes vitamin D deficiency, in itself another disease
mostly missed and it causes severe fatigue, muscle aches and weakness and
tremendous bone pains usually misdiagnosed as fibromyalgia.
Celiac disease should be thought of in investigating osteoporosis with
severe reduction in Z-scores.
Celiac disease causes unexplained elevation in liver enzymes,
including alkaline phosphatase, which could rise partly due to its bone
component due to osteomalacia and vitamin D deficiency.
celiac disease can cause explained seizures and electrolyte imbalances
such as hypocalcemia, when the vitamin D deficiency is severe.
Celiac disease could cause peripheral neuropaty via vitamin B12
deficiency.
Celiac disease can cause skin rash and should be in the differential
diagnosis of such disorder.
Celiac disease is associated with other autoimmune disorders such as type
1 diabetes, and should be in the differential diagnosis of hypoglycemia in
every patient with type 1 diabetes.
Celiac disease can cause low night vision via vitamin A deficiency
and every patient with vitamin A deficiency should be screened.
Patients, especially women with alopecia should be screened for iron and
zinc deficiency, both are nutritional factors in hair growth. Zinc
deficiency can also cause dyguisia, recurrent upper respiratory
infections, and low night vision.
Patients with hypothyroidism whose TSH is always high despite huge doses
of levothyroxine must be screened for celiac disease provided they take
leveothyroxine on an empty stomach without food or coffee or other
medications for at least an hour before breakfast.
Celiac disease could also an underlying cause for elevated
homocysteine and abdominal bacterial overgrowth causing even more
gastrointestinal symptoms such as pain or bloating.
Shirwan Mirza, MD, FACP, FACE
References:
1. Published 19 February 2009, BMJ 2009;338:a3058
Practice
Easily Missed?
Coeliac disease Roger Jones, Wolfson professor of general practice, Sarah Sleet,
chief executive
2. Celiac disease. Guandalini S, Setty M. Curr Opin Gastroenterol. 2008 Nov;24(6):707-12.
3. Celiac disease. Catassi C, Fasano A. Curr Opin Gastroenterol. 2008 Nov;24(6):687-91.
Competing interests:
None declared
Competing interests: No competing interests