Celiac disease history and symptoms: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(Created page with "__NOTOC__ {{Celiac disease}} {{CMG}} ==Overview== ==History and Symptoms== * May be asymptomatic * Vague abdominal pain * Diarrhea * Weight loss * [[Malabsorption...")
 
m (Bot: Removing from Primary care)
 
(49 intermediate revisions by 7 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Celiac disease}}
{{Celiac disease}}
{{CMG}}
{{CMG}} ; {{AE}} {{ADG}}


==Overview==
==Overview==
==History and Symptoms==
Celiac disease may present with typical [[symptoms]] such as [[Diarrhea|diarrhea,]] [[steatorrhea]], [[weight loss]], and [[growth failure]] or non-typical [[symptoms]] not involving the [[gastrointestinal tract]]. The classic presentation of celiac disease is more common in young children, consisting primarily of [[Gastrointestinal tract|gastrointestinal]] [[symptoms]]. In adults, the presentation of celiac disease is often more subtle and can be mistaken for [[irritable bowel syndrome]]. Some patients lack any evident [[gastrointestinal]] [[symptoms]] and instead present with [[nutritional deficiencies]] (most commonly [[iron deficiency]]) or extra-intestinal [[symptoms]], or are [[asymptomatic]].
* May be asymptomatic
 
* Vague [[abdominal pain]]
==History==
A detailed and thorough history from the patient is necessary. It provides insight into the cause, precipitating factors and associated [[Comorbidity|comorbid]] conditions. Specific areas of focus when obtaining a history from the patient with celiac disease include:<ref name="pmid17960014">{{cite journal |vauthors=Green PH, Cellier C |title=Celiac disease |journal=N. Engl. J. Med. |volume=357 |issue=17 |pages=1731–43 |year=2007 |pmid=17960014 |doi=10.1056/NEJMra071600 |url=}}</ref>
*Unexplained [[Gastrointestinal diseases|gastrointestinal symptoms]]
*[[Chronic diarrhea]]
*[[Symptoms]] of [[fatigue]] and [[tiredness]] ([[iron deficiency anemia]])
*[[Skin rash]] consistent with [[dermatitis herpetiformis]]
*[[Family history]] of celiac disease and [[inflammatory bowel disease]]
 
==Symptoms==
Celiac disease may present with typical [[symptoms]] such as [[Diarrhea|diarrhea,]] [[steatorrhea]], [[weight loss]], and [[growth failure]] or non-typical [[symptoms]] involving extra-intestinal manifestations. The classic presentation of celiac disease is more common in young children, consisting primarily of [[Gastrointestinal tract|gastrointestinal]] [[symptoms]]. In adults, the presentation of celiac disease is often more subtle and can be mistaken for [[irritable bowel syndrome]]. Some patients lack any evident [[gastrointestinal]] [[symptoms]] and instead present with [[nutritional deficiencies]] (most commonly [[iron deficiency]]) or extra-intestinal [[symptoms]], or are [[asymptomatic]].
 
'''The following table summarizes the symptoms of celiac disease in adults.'''<ref name="pmid12741468">{{cite journal |vauthors=Zipser RD, Patel S, Yahya KZ, Baisch DW, Monarch E |title=Presentations of adult celiac disease in a nationwide patient support group |journal=Dig. Dis. Sci. |volume=48 |issue=4 |pages=761–4 |year=2003 |pmid=12741468 |doi= |url=}}</ref><ref name="pmid25003268">{{cite journal |vauthors=Lasa JS, Zubiaurre I, Soifer LO |title=Risk of infertility in patients with celiac disease: a meta-analysis of observational studies |journal=Arq Gastroenterol |volume=51 |issue=2 |pages=144–50 |year=2014 |pmid=25003268 |doi= |url=}}</ref><ref name="pmid19018335">{{cite journal |vauthors=Freeman HJ |title=Neurological disorders in adult celiac disease |journal=Can. J. Gastroenterol. |volume=22 |issue=11 |pages=909–11 |year=2008 |pmid=19018335 |pmc=2661192 |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><ref name="pmid23601438">{{cite journal |vauthors=Casella G, Antonelli E, Di Bella C, Villanacci V, Fanini L, Baldini V, Bassotti G |title=Prevalence and causes of abnormal liver function in patients with coeliac disease |journal=Liver Int. |volume=33 |issue=7 |pages=1128–31 |year=2013 |pmid=23601438 |doi=10.1111/liv.12178 |url=}}</ref><ref name="pmid24979198">{{cite journal |vauthors=Troncone R, Discepolo V |title=Celiac disease and autoimmunity |journal=J. Pediatr. Gastroenterol. Nutr. |volume=59 Suppl 1 |issue= |pages=S9–S11 |year=2014 |pmid=24979198 |doi=10.1097/01.mpg.0000450394.30780.ea |url=}}</ref>
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms frequency
! colspan="8" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Intestinal
! colspan="7" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Extra-intestinal
|-
! align="center" style="background:#DCDCDC;" |Hematologic
! align="center" style="background:#DCDCDC;" |Dermatologic
! align="center" style="background:#DCDCDC;" |Neurologic
! align="center" style="background:#DCDCDC;" |Musculoskeletal
! align="center" style="background:#DCDCDC;" |Hepatic
! align="center" style="background:#DCDCDC;" |Renal
! align="center" style="background:#DCDCDC;" |Cardiac
|-
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Common
Symptoms
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Recurrent abdominal pain]]
* [[Diarrhea]]
* [[Diarrhea]]
* [[Vomiting]]
* [[Occult blood|Occult blood in stool]]
* [[Steatorrhea]] 
* [[Weight loss]]
* [[Weight loss]]
* [[Malabsorption]] / [[steatorrhea]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*:* ''Symptoms and pathologic changes resolve with gluten-free diet''
* [[Bruising]]
 
* [[Fatigue]]
In majority of cases diagnosis can be made reliably with blood testing, but the "gold standard" is still small bowel intestinal biopsy (obtained via EGD). Ideally, a small bowel biopsy should be taken while the patient is on a gluten diet and then checked against a follow-up biopsy after 12 weeks on a gluten-free diet. IgA anti-endomysial antibody (EmA) is at least 99% specific, and about 93% sensitive, but some studies show it to be nearly 100% specific and sensitive. Tissue anti-transglutaminase (tTG) antibody is similarly accurate. Total serum IgA is usually normal, but may be low to undetectable in a small percentage patients.  If total IgA is very low, EmA and tTG will not be accurate and a small bowel biopsy should be considered. IgA anti-gliadin antibody (AGA) is more useful as a screening test, and neither anti-gliadin IgA or IgG antibodies are as specific or sensitive as anti-endomysial antibodies or anti-transglutaminase antibodies.
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 
* [[Glossitis]]
Classic symptoms of coeliac disease include [[diarrhoea]], [[weight loss]] (or stunted growth in children), and [[fatigue (physical)|fatigue]], but while coeliac disease is primarily a bowel disease, bowel symptoms may also be limited or even absent. Some patients are diagnosed with symptoms related to the decreased absorption of nutrients or with various symptoms which, although statistically linked, have no clear relationship with the malfunctioning bowel. Given this wide range of possible symptoms, the classic triad is no longer a requirement for diagnosis.
* [[Cheilosis|Angular cheilosis]]  
* [[Lichen planus]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Dementia]]
* [[Depression]]
* [[Gait|Altered gait]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Back pain]]
* [[Flank pain|Flank tenderness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Hepatosplenomegaly]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|-
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Less common
symptoms
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Constipation]] 
* [[Flatulence]]
* Secondary [[lactose intolerance]]
* [[Dyspepsia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Bleeding]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Blisters]]
* [[Maculopapular rash]]
* [[Pustules]]
* [[Alopecia]]
* Erosive buccal lesions
* [[Eczema]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Ataxia]]
* [[Seizure|Seizures]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Arthralgia]]
* [[Deformities]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Ascites]]
* [[Jaundice]]
* [[Gynecomastia]]
* [[Spider angioma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Hematuria]]
* [[Dysuria]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Chest pain]]
* [[Fatigue]]
* [[Shortness of breath]]
* [[Edema]]
|}


Children between 9 and 24 months tend to present with bowel symptoms and growth problems shortly after first exposure to gluten-containing products. Older children may have more malabsorption-related problems and psychosocial problems, while adults generally have malabsorptive problems.<ref name=Ciclitira>{{cite web | first = P | last = Ciclitira  | year= 2002 | url = http://www.bsg.org.uk/bsgdisp1.php?id=c9c5177d2b91e3228066 | title = Interim Guidelines for the Management of Patients with Coeliac Disease | publisher = British Society of Gastroenterology | accessdate = 2007-03-07}}</ref> Many adults with subtle disease only have fatigue or [[anaemia]].<ref name=VanHeelWest/>
In children gastrointestinal symptoms predominate than extra-intestinal symptoms in celiac disease. Symptoms include:<ref name="pmid8338991">{{cite journal |vauthors=Bottaro G, Failla P, Rotolo N, Sanfilippo G, Azzaro F, Spina M, Patane R |title=Changes in coeliac disease behaviour over the years |journal=Acta Paediatr. |volume=82 |issue=6-7 |pages=566–8 |year=1993 |pmid=8338991 |doi= |url=}}</ref><ref name="pmid16322131">{{cite journal |vauthors=Rashid M, Cranney A, Zarkadas M, Graham ID, Switzer C, Case S, Molloy M, Warren RE, Burrows V, Butzner JD |title=Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children |journal=Pediatrics |volume=116 |issue=6 |pages=e754–9 |year=2005 |pmid=16322131 |doi=10.1542/peds.2005-0904 |url=}}</ref><ref name="pmid15321874">{{cite journal |vauthors=van Rijn JC, Grote FK, Oostdijk W, Wit JM |title=Short stature and the probability of coeliac disease, in the absence of gastrointestinal symptoms |journal=Arch. Dis. Child. |volume=89 |issue=9 |pages=882–3 |year=2004 |pmid=15321874 |pmc=1763207 |doi=10.1136/adc.2004.057851 |url=}}</ref>
===Common symptoms of celiac disease in children===
*[[Abdominal pain]]
*[[Weight loss]]
*[[Diarrhea]]
*[[Failure to thrive]]


* Behavioural changes
===Less common symptoms of celiac disease in children===
* Fatigue, malaise
*[[Anorexia]]
* Growth delay
*[[Abdominal distention]]
* weight loss (explained and unexplained)
*[[Vomiting]]
*[[Bloating]]
*[[Growth failure]]
*[[Irritability]]
*[[Fatigue]]
*Irregular [[bowel]] habits


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Gastroenterology]]
[[Category:Rheumatology]]
[[Category:Autoimmune diseases]]
[[Category:Genetic disorders]]
[[Category:Malnutrition]]
[[Category:Pediatrics]]
[[Category:Dermatology]]
[[Category:Up-To-Date]]

Latest revision as of 20:50, 29 July 2020

Celiac disease Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Celiac disease from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Life Style Modifications
Pharmacotherapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Celiac disease history and symptoms On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Celiac disease history and symptoms

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

National Guidelines Clearinghouse

NICE Guidance

FDA on Celiac disease history and symptoms

CDC on Celiac disease history and symptoms

Celiac disease history and symptoms in the news

Blogs onCeliac disease history and symptoms

Directions to Hospitals Treating Celiac disease

Risk calculators and risk factors for Celiac disease history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Celiac disease may present with typical symptoms such as diarrhea, steatorrhea, weight loss, and growth failure or non-typical symptoms not involving the gastrointestinal tract. The classic presentation of celiac disease is more common in young children, consisting primarily of gastrointestinal symptoms. In adults, the presentation of celiac disease is often more subtle and can be mistaken for irritable bowel syndrome. Some patients lack any evident gastrointestinal symptoms and instead present with nutritional deficiencies (most commonly iron deficiency) or extra-intestinal symptoms, or are asymptomatic.

History

A detailed and thorough history from the patient is necessary. It provides insight into the cause, precipitating factors and associated comorbid conditions. Specific areas of focus when obtaining a history from the patient with celiac disease include:[1]

Symptoms

Celiac disease may present with typical symptoms such as diarrhea, steatorrhea, weight loss, and growth failure or non-typical symptoms involving extra-intestinal manifestations. The classic presentation of celiac disease is more common in young children, consisting primarily of gastrointestinal symptoms. In adults, the presentation of celiac disease is often more subtle and can be mistaken for irritable bowel syndrome. Some patients lack any evident gastrointestinal symptoms and instead present with nutritional deficiencies (most commonly iron deficiency) or extra-intestinal symptoms, or are asymptomatic.

The following table summarizes the symptoms of celiac disease in adults.[2][3][4][5][6][7]

Symptoms frequency Symptoms
Intestinal Extra-intestinal
Hematologic Dermatologic Neurologic Musculoskeletal Hepatic Renal Cardiac
Common

Symptoms

- -
Less common

symptoms

In children gastrointestinal symptoms predominate than extra-intestinal symptoms in celiac disease. Symptoms include:[8][9][10]

Common symptoms of celiac disease in children

Less common symptoms of celiac disease in children

References

  1. ↑ Green PH, Cellier C (2007). "Celiac disease". N. Engl. J. Med. 357 (17): 1731–43. doi:10.1056/NEJMra071600. PMID 17960014.
  2. ↑ Zipser RD, Patel S, Yahya KZ, Baisch DW, Monarch E (2003). "Presentations of adult celiac disease in a nationwide patient support group". Dig. Dis. Sci. 48 (4): 761–4. PMID 12741468.
  3. ↑ Lasa JS, Zubiaurre I, Soifer LO (2014). "Risk of infertility in patients with celiac disease: a meta-analysis of observational studies". Arq Gastroenterol. 51 (2): 144–50. PMID 25003268.
  4. ↑ Freeman HJ (2008). "Neurological disorders in adult celiac disease". Can. J. Gastroenterol. 22 (11): 909–11. PMC 2661192. PMID 19018335.
  5. ↑ 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.
  6. ↑ Casella G, Antonelli E, Di Bella C, Villanacci V, Fanini L, Baldini V, Bassotti G (2013). "Prevalence and causes of abnormal liver function in patients with coeliac disease". Liver Int. 33 (7): 1128–31. doi:10.1111/liv.12178. PMID 23601438.
  7. ↑ Troncone R, Discepolo V (2014). "Celiac disease and autoimmunity". J. Pediatr. Gastroenterol. Nutr. 59 Suppl 1: S9–S11. doi:10.1097/01.mpg.0000450394.30780.ea. PMID 24979198.
  8. ↑ Bottaro G, Failla P, Rotolo N, Sanfilippo G, Azzaro F, Spina M, Patane R (1993). "Changes in coeliac disease behaviour over the years". Acta Paediatr. 82 (6–7): 566–8. PMID 8338991.
  9. ↑ Rashid M, Cranney A, Zarkadas M, Graham ID, Switzer C, Case S, Molloy M, Warren RE, Burrows V, Butzner JD (2005). "Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children". Pediatrics. 116 (6): e754–9. doi:10.1542/peds.2005-0904. PMID 16322131.
  10. ↑ van Rijn JC, Grote FK, Oostdijk W, Wit JM (2004). "Short stature and the probability of coeliac disease, in the absence of gastrointestinal symptoms". Arch. Dis. Child. 89 (9): 882–3. doi:10.1136/adc.2004.057851. PMC 1763207. PMID 15321874.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Celiac_disease_history_and_symptoms&oldid=1635799"