Risk of Morbidity in Contemporary Celiac Disease

Nina R Lewis; Geoffrey KT Holmes

Disclosures

Expert Rev Gastroenterol Hepatol. 2010;4(6):767-780. 

In This Article

Other Gastrointestinal Disorders

Irritable bowel syndrome is common, but only a small percentage of patients are referred to hospital for evaluation. Symptoms such as abdominal bloating, diarrhea and constipation are common to irritable bowel syndrome and celiac disease, so the two conditions are easily confused.[156,157] A search for celiac disease in irritable bowel syndrome can be supported, because in a meta-analysis involving 14 studies of individuals with irritable bowel syndrome, the prevalence of celiac disease was increased fourfold.[158] For those symptoms due to celiac disease, a gluten-free diet would be expected to be effective. However, a gluten-free diet may still be beneficial in those with symptoms owing to irritable bowel syndrome in the absence of celiac disease.[159]

Using the Swedish In-Patient Registry, celiac disease was associated with an increased risk of subsequent pancreatitis (HR: 3.3 [95% CI: 2.6–4.4]).[160] Celiac disease and noncirrhotic intrahepatic hypertension may occur together, but the reasons are unknown.[161]

Enamel defects and recurrent aphthous ulcers are observed in patients with celiac disease, but prevalence figures vary surprisingly widely.[162] Enamel hypoplasia had the same frequency in celiac patients and controls,[162] but a higher prevalence in patients has been reported.[163,164] It is difficult to account for these differing results, but differences in foods consumed by the various groups may be one explanation. Autoimmune mechanisms may also play a part, but malabsorption does not appear to be of importance.[165] Recurrent aphthous ulcers occur more commonly in patients with celiac disease in some series[162,164] but not all.[166] The frequency of celiac disease in those with recurrent ulcers may be higher that in the general population with a threefold increase, but small bowel histological changes may be mild.[167] When ulcers are present, a gluten-free diet is an effective cure.[168] Clinicians need to be aware of the oral manifestations, which include glossitis and angular stomatitis, and that may be the chief or only manifestations of celiac disease.

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