Extraintestinal Manifestations of Celiac Disease and Associated Disorders

Alfredo J Lucendo, Luis Rodrigo, A. Salvador Peña


Celiac disease is not limited to the gastrointestinal tract and belongs to the group of autoimmune systemic diseases. It is frequently accompanied by a variety of extra digestive manifestations. More than half of the patients with adult celiac disease present with extra intestinal manifestations. The majority improve on a gluten-free diet. It is therefore advisable to have a low threshold of suspicion for the diagnosis. The most frequent extraintestinal manifestations are iron deficiency anemia, osteoporosis, and dermatitis herpetiformis. The causes for the onset and manifestation of associated diseases are diverse; some share a similar genetic base, like type-1 diabetes mellitus; others share pathogenic mechanisms, and yet, others are of unknown nature. The implementation of a gluten-free diet improves the overall clinical course and influences the evolution of the associated diseases. In some cases, such as iron deficiency anemia, the gluten-free diet cures the manifestations and in other disorders, like in type.1 diabetes allows a better control of the disease. In several associated diseases, an adequate adherence to a gluten-free diet may slow their evolution, especially if implemented at an early stage. We have reviewed in this chapter, first, the intra and extra intestinal manifestations of celiac disease, such as oral manifestations, hematological disorders, and osteoporosis. Secondly, the gluten-related associated diseases with genetic links, such as dermatitis herpetiformis and gluten ataxia. Finally, from the associated diseases we have reviewed type-1 diabetes mellitus, thyroid diseases, and malignancy.

Palabras clave

Celiac disease, Extraintestinal manifestations, Associated disorders, Gluten-related diseases, anemia, osteoporosis, malignancy

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