Atypical Celiac Disease Symptoms
Signs, Symptoms, and Related Disorders in Gluten Sensitivity
May 31, 2007
Common symptoms of celiac disease and its variant gluten sensitivity enteropathy, conditions which affect about one percent of the population, include gastrointestinal manifestations, such as nausea, vomiting, gas, flatulence, diarrhea, constipation, bloating, and stomach cramps. Besides these symptoms, celiac disease can cause a number of other symptoms, signs and related illnesses affecting various bodily systems including the skin, blood (hematologic system), bone, and the systemic organs. Symptoms often occur as a result of the nutrient deficiencies, especially those of essential oils, oil-soluble vitamins, and minerals, that occur in celiac disease.
General Systemic Symptoms
Adults with celiac disease often develop symptoms of lassitude, inanition, secondary hyperparathyroidism (due to vitamin D deficiency), hypoglycemia, amenorrhea, impotence, and infertility (related to malabsorption with protein-calorie malnutrition and probably vitamin D and calcium deficiencies), depression, fatigue, irritability, and general malnutrition with or without weight loss. In children, systemic symptoms include irritability, fretfulness, emotional withdrawal or excessive dependence, nausea, anorexia, malnutrition with distended abdomen, muscle wasting of buttocks, thighs and proximal arms, with or without vomiting and diarrhea, and stunted growth.
Skin and Mucous Membranes
Skin and mucous membrane changes include apthous stomatitis (recurrent canker sores), atopic dermatitis, dermatitis herpetiformis, scaly dermatitis or acrodermatitis (due to zinc deficiency), hyperpigmented dermatitis (due to niacin deficiency), edema (protein malabsorption), alopeacia areata, vitiligo, bruising and purpura (related to vitamin K deficiency), melanosis (chloasma bronzium) a disorder of hyperpigmentation, and erythema nodosum.
Nervous System
Nervous system changes include xerophthalmia and night blindness related to vitamin A deficiency and peripheral neuropathy related to vitamin B12 and thiamine deficiency.
Skeletal System
Bone changes include osteoporosis/osteopenia, (seen in nearly 100 percent of patients with celiac disease), dental enamel defects, short stature, arthritis or arthralgia (especially central arthritis-sacroiliitis), bone pain, especially nocturnal (occurring at night).
Hematologic System
Common blood changes include anemia, especially iron deficiency anemia and folic acid deficiency, low white blood cell count (leucopenia), coagulation disorders, and thrombocytopenia (platelet deficiency).
Associated Disorders
A number of autoimmune and other disorders are highly associated with celiac disease. These include Down’s syndrome, autoimmune thyroid disease, seizures (seizures resolve after treatment with a gluten free diet), liver disease, type 1 diabetes mellitus,
Resources:
P Collin and T Reunala, Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists, American Journal of Clinical Dermatology, 2003; 4(1): 13-20.
David Nelsen, Gluten-Sensitive Enteropathy (Celiac Disease): More Common Than Your Think, American Family Physician, December 15, 2002, 2259-2270.
Harold Pruessner, Detecting Celiac Disease in Your Patients, American Family Physician, Vol 57, March 1, 1998: 103-1055.
