Spectrum of clinical presentations and associated conditions

The classical presentation of celiac disease includes diarrhea, failure to thrive or weight loss, abdominal distention, flatulence and fatigue. However, during the past two decades there has been an increasing awareness that there are many less dramatic or classical presentations of celiac disease including iron-deficiency anemia, folate deficiency, osteopenic bone disease, as well as relatively non-specific gastrointestinal (GI) symptoms (Table 6.2). These so-called "atypical" forms of celiac disease are now more common than classical celiac

Table 6.2 Presentations of Celiac Disease

Classical celiac disease of childhood Later onset GI symptoms Often mistaken for IBS Can be non-specific Extraintestinal presentations Dermatitis herpetiformis Iron deficiency Folate deficiency Osteopenic bone disease Chronic fatigue

Neuropsychiatry manifestations

Short stature

Infertility

Obstetrical complications Asymptomatic celiac disease

Often in relatives Latent celiac disease disease [4]. Studies as well as anecdotal experience indicate that many of these patients remain undiagnosed for years in spite of unexplained symptoms or abnormal blood tests. Other terms of questionable clinical significance are "silent" or "latent" celiac disease, which are used respectively when subjects are asymptomatic, but have serological and histological evidence of celiac disease or when serology is positive without symptoms or histological changes of celiac disease.

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