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"It's
now clear that the text book description of this once-obscure ailment
is woefully incomplete and describes only a minority of cases. Below
the tip of the so-called celiac iceberg is a diverse world of illness
that may include thousands of people suffering from various, seemingly
unrelated conditions, such as anemia, osteoporosis, infertility,
irritable bowel syndrome and chronic fatigue." - The
Washington Post, February 11, 2003
List
of CD Symptoms from :
Harvard
University
University of Chicago
Columbia
University
Go to the bottom of the Columbia University page to find a
table of indications for screening
for CD.
Note:
A person with CD may have only ONE of these symptoms. So,
someone with anemia who has no digestive problems, could have
CD. Likewise, someone with digestive problems who has never
been anemic, could also have CD!
Celiac Disease "runs in the family", so you may
see symptoms in family members as well (that are different
than yours).
How
to make sense of all those symptoms
It
has been estimated that there are 208 signs and symptoms of Celiac
Disease! Ultimately, all of these are interrelated, and are the
result of the autoimmune reaction to gluten, which may affect the
entire body.
Since
it is difficult to communicate or remember so many symptoms, it
is useful to categorize these in the "big three" areas
of Malabsorption, Autoimmune and Digestive
symptoms. (You can remember this with the acronym M.A.D., as in
"I'm MAD that gluten does this to people"!)
Malabsorption:
the result of inadequate absorption of nutrients from the damaged
small intestine. The symptoms can range from mild to severe, and
include:
iron
deficiency anemia, fatigue, B-12 and folate deficiency, osteopenia,
osteoporosis, "failure to thrive" in children, short
stature, dental enamel defects, protein calorie malnutrition,
unintended weight loss, steatorrhea.
Autoimmune
symptoms and diseases. This is a large category. Common
symptoms of autoimmunity, such as joint pain, fatigue, and hair
loss, can be caused by Celiac Disease. The joint pain is often misdiagnosed
as Fibromyalgia. The fatigue may be diagnosed as chronic fatigue
syndrome, or simply as stress.
Up
to 10% of people with Type 1 Diabetes have Celiac Disease, and it
is recommended that anyone with Type 1 Diabetes should be screened
for CD. CD is strongly associated with autoimmune thyroid disease
and Sjogren's Syndrome. It is also associated with alopecia, psoriasis,
lupus, Addison's Disease, and cardiomyopathy. There is some evidence
that gluten may cause autoimmune diseases.
CD
is also believed to cause nerve damage of autoimmune origin, such
as peripheral neuropathy, small-fiber neuropathy, ataxia, and symptoms
that may be misdiagnosed as multiple sclerosis.
There
are other effects from CD that are harder to categorize, but may
fall into the autoimmune category, such as dermatitis herpetiformis,
and effects on blood vessels and circulation.
See
this pamphlet
for a description of the autoimmune diseases associated with Celiac
Disease.
Digestive
symptoms. A number of common digestive problems may be
caused by gluten, such as diarrhea and constipation (frequently
misdiagnosed as Irritable Bowel Syndrome), vomiting, bloating, gas,
reflux, lactose intolerance, and dyspepsia. The symptoms can range
from mild to severe.
CD
can also cause many less common problems in the digestive system,
such as motility disorders and intestinal cancers, elevated liver
enzymes, and S.O.D., or Sphincter of Oddi dysfunction (which can
cause blockage of the bile and pancreatic ducts, gallbladder-type
pain, and pancreatitis).
Below
is a list of signs, symptoms, associated disorders and typical misdiagnoses
of Celiac
Disease, with selected references (this is a work in progress):
Abdominal
pain (Naspghan
pediatric guidelines)
Addison's Disease (1,
2,
3)
Alopecia
Anemia
(Grisolano,
SW)
Anorexia (Naspghan
pediatric guidelines)
Apthous ulcers ie, mouth sores
Arthritis (Stagi
S)
Arthropathy
Ataxia (Hadjivassiliou,
Hadjivassiliou)
Atrial Fibrillation (Candelli
M)
Cardiomyopathy (Goel,NK)
Constipation (Naspghan
pediatric guidelines)
Crohn's Disease (Tursi
A)
Delayed Puberty (Naspghan
pediatric guidelines)
Depression (Pynnonen
P)
Dental Enamel Defects (Aine
L)
Dermatitis Herpetiformis
Diabetes, Type 1 (Mahumd
F, Picarelli)
Diarrhea
Down's Syndrome
Elevated liver enzymes (hypertransaminasemia) (Duggan)
Epilepsy
Graves Disease
Growth Hormone Deficiency (Salardi
S)
Hair loss (not male pattern baldness)
Heart Problems (Cardiomyopathy,
Myocarditis,
Ventricular
Arrythmia)
Hepatitis
Hives (urticaria) (Caminiti,
Meneghetti)
Hashimoto's Thyroiditis
Hyposplenism (ie, poor function of spleen increasing risk of infection)
(Di
Sabatino)
Hypertransaminasemia (ie, elevated liver enzymes)
Infertility, male or female
Irritability
Irritable Bowel Syndrome
Kawasaki Disease (Stagi)
Lactose Intolerance (Ojetti)
Lupus (Hadjivassiliou)
Lymphoma
Migraines (Gabrielli)
Myelopathy
Myocarditis (Frustaci)
Multiple Sclerosis
Nystagmus (Mohn
A)
Osteopenia
Osteoporosis (1)
Pancreatitis (1,
2
3)
Peripheral
Neuropathy
Primary Biliary Cirrhosis
Psoriasis
Pulmonary (lung) inflammation (Brightling)
Reflux
Schizophrenia (Kalaydjian)
Seizures
Short Stature (Salardi
S)
Sjogren's Syndrome (Luft)
Sphincter of Oddi dysfunction, aka papillary stenosis (Patel
RS)
Steatorrhea
Thyroid
Disease, Autoimmune
Turner Syndrome
Ventricular Arrythmia (Frustaci)
Vertigo (Mohn
A)
Vomiting
Weight Loss (unintentional)
Weight Gain (from increased appetite)
Williams Syndrome
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