Celiac Disease: The Great Mimic Presentation

Widodo Judarwanto MD, Indonesia Celiac Clinic
BACK GROUND
Celiac disease is an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals. It occurs in children and adolescents with gastrointestinal symptoms, dermatitis herpetiformis, dental enamel defects, osteoporosis, short stature, delayed puberty, persistent iron deficiency anemia and in asymptomatic individuals with type 1 diabetes, Down syndrome, Turner syndrome, Williams syndrome, selective IgA deficiency and first degree relatives of individuals with celiac disease. The Celiac Disease Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition has formulated a clinical practice guideline for the diagnosis and treatment of pediatric celiac disease based on an integration of a systematic review of the medical literature combined with expert opinion.
About 1% of the population have undetected coeliac disease. Classic coeliac disease has been associated with a 2-fold increased risk of death and malignant disease particularly lymphoma and bone problems.
People with coeliac disease appear to be at reduced risk of vascular disease and breast cancer. It is not known whether people with undetected or non-classic coeliac disease have the same risks from the disease or benefits from treatment with a gluten-free diet as those with classic coeliac disease. We aim to determine whether treatment with a gluten-free diet alters the risk factors for vascular disease and breast cancer in patients with coeliac disease and to examine the mortality risks associated with undetected coeliac disease.
The possible benefit or even unexpected adverse effects of exposure to a gluten-free diet will influence national gluten-free diet prescribing guidelines and will rapidly translate into improvements in health care.

THE GREAT IMMITATOR
Many medical institutions provide lists of symptoms and health problems associated with Celiac Disease and gluten sensitivity. The list I present here is a compilation of several such lists. I have found these lists lacking in explanations of how gluten is related to each symptoms or condition. Furthermore, these lists lack descriptions of the conditions for the non-medical person (“What the heck is ‘aphthous stomatitis’, anyway?”). I am developing this list not only for the reader’s interest, but also for my own easy reference.

The very length of the lists made me dubious at first – how could one thing cause so much? Even more so, how could one thing cause or contribute to opposite problems like skinniness and obesity, diarrhea and constipation, insanity and genius? The very idea was hard to swallow, as it were. Once I could no longer deny that gluten does indeed cause and contribute to many problems as I found them in my body, I decided to teach myself how wheat gluten can do it all.

Let me point out now that having none of the following conditions is no proof that you are free from sensitivity to gluten. Neither is having any of these symptoms proof that you are sensitive. But all of these symptoms (and more not listed) should cause suspicion of gluten intolerance – some should cause a LOT of suspicion. Celiacs who have chronic symptoms are expected to develop even more chronic symptoms if they don’t stop eating gluten.[1] (Maybe a new one every two to six years, give or take?) All research papers cited in the following annotations conclude that ALL people with the listed conditions should be tested.

This annotated list is intended to be informative rather than diagnostic – I want to raise curiosity and suspicion. Readers are most strongly encouraged to further study any listed symptoms they recognize in themselves, their blood relatives, and their friends. Your doctor can only work with you 15 minutes at a time – You are with yourself at least most of the time. Caveat: Even though some very serious factors other than gluten sensitivity (such as tumors) can be involved with many of these problems, gluten sensitivity is common if not pandemic in its association with the listed symptoms and conditions.

Because a number of common factors of gliadin sensitivity lie under many different symptoms and diseases, I have prepared a short essay titled The Basics Factors of Gluten Sensitivity and Celiac Disease. The following descriptions make many references to the factors discussed in that essay.

Celiac Symptoms from Celiac Sprue Association/USA, Inc.
· Muscle Twitch
· Irritability.
· Diarrhea.
· Underweight
· Gas
· Delayed growth.
· Problems with memory and concentration.
· Anemia.
· Fatigue
· Bone problems. If you are interested in a specific condition for which you know the name, look in The Long List. Otherwise, please check out The Short List, which is organized by general subjects of high interest. The initial sources for the conditions I list here came from many lists on medical sites – if you are interested, please see the Symptom Lists From Established Medical Sites a ways down this page.

The Short List:
(Developer’s Note: This annotation is an ongoing project. I have 3+ years of research collected, but little time now to put it on line. Subjects that friends or family ask about have priority. Underlined entries are hypertext links to annotation pages that are at least partially developed.)
Diabetes
Headaches/Migraines
Rashes/Skin Problems
Arthritis
Brain/Nerve Damage
Seizures
Thyroid Disease
Developmental Disorders
Heart Disease
Sexual Issues
Depression/Mood Problems
Digestive Problems
Eye Problems
Hair Loss/White Hair
Food Cravings
Birth Defects
Alcoholism/Drugs
Skinniness/Obesity
Fatigue
Infertility, Miscarriage and other Reproductive Problems
Mouth/Dental
Lungs/Colds
Malabsorption
Weak Bones
Dizziness/Clumsiness
Eccentricity/Genius
Muscle Pain
Social Problems
Vitamin Deficiencies
Bad Teeth
Shortness/Delayed Growth
Pancreas/Gall Bladder
Cancer/Leukemia
Frequent Colds/Lung Infections

The Long List:
Some conditions appear more than once in this list where I may include both a technical name and multiple common names for a single condition.
Abdominal Distention
Abdominal Pain, Recurrent
Acid Reflux
Acne
ADD/ADHD
AIDS
ALS
Alzheimer’s AI
Addison’s disease (loss of adrenal glands) AI
Alopecia Areata (hair loss)
Anemia
Anxiety and depression
Aphthous stomatitis, Recurrent AI Mal
Arthralgia or arthropathy
Arthritis
Asperger’s Syndrome
Asthma
Ataxia
Autism
Bad Teeth:
Bi-Polar Disorder
Bird-fancier’s lung
Birth Defects
Blindness
Bloating
Bone problems
Bruising, Vitamin K deficiency
Cancer, Lymphoma, Enteropathy-associated T cell
Candidiasis
Carcinoma of the oropharynx, esophagus, and small bowel
Carpal Tunnel/Cubital Tunnel
Cistitis, intersitial
Celiac Disease
Chronic Fatigue
Clumsiness
Cluster Headaches
Colds, Frequent
Colitis, Microscopic and collagenous
Collagenous sprue
Concentration Problems
Constipation
Crohn’s Disease
Cystic Fibrosis
Delayed growth
Delayed puberty
Dementia
Depression
Dermatitis Herpetiformis
Diabetes Type 1 Mellitus
Diabetes Type 2
Diabetes, brittleness of control
Diarrhea
Diarrhea, Osmotic
Diarrhea, Secretory
Diverticulosis / Diverticulitis
Divorce
Dizziness
Down Syndrome
Drug Use
Dry Skin
Duodenal Obstruction
Dyspepsia
Ear Infections / Ear Itching & Drainage
Epilepsy (with or w/o cerebral/ occipital calcification)
Eczema
Failure to thrive
Fatigue
Female Reproductive system problems.
Fibromyalgia
Fibrosing alveolitis
Folate-deficiency anemia
Follicular keratosis
Food Cravings
Frequent respiratory infections
Gas
Gastroparesis (Slow Stomach)
Grave’s Disease
Hair Loss
Hay Fever
Headaches
Heart Disease
Heel Fissures
Hepatitis, Autoimmune (liver problem)
Huntington’s Disease
Hyperactivity
Hypertension
Hypertransaminasemia (liver problem)
Hypoglycemia
Hypoplasia (Bad Teeth)
Hypotonia
Idiopathic pulmonary hemosiderosis
IgA deficiency
IgA nephropathy, mesangial
Infertility
Inflammatory bowel disease
Iron deficiency
Irritability
Irritable Bowel Syndrome (IBS)
Jejunoileitis, Ulcerative
Joint Pain, Chronic
Lactose Intolerance
Leaky Gut
Leukemia
Lung Cavities/Lung Infections
Lupus, Systemic lupus erythematosus
Marriage Problems
Memory Problems
Migraine Headaches
Miscarriages, Abortions
Muscle Twitch
Myasthenia gravis
Myocarditis (heart)
Neuropathy
Night Blindness
Obesity
Occult (hidden) blood in stool
Osteomalcia
Osteoporosis/Osteopenia
Pancreatitis, Recurrent
Pericarditis, Recurrent (heart)
Polymyositis
Polyneuropathy
Potbelly
Primary biliary cirrhosis
Psoriasis
Psychiatric disorders
Pulmonary hemosiderosis
Recurrent abortions
Refractory sprue
Rheumatoid arthritis
Sarcoidosis
Scaly Skin
Schizophrenia
Seizures
Self-Medication
Sexual Problems
Short stature
Sinusitis
Sjögren’s Syndrome
Skin Rashes
Skin Sensitivity and Pain
Skinniness (hollow leg)
Slow Stomach (Gastroparesis)
Snow White Hair
Spinocerebellar syndrome
Social Difficulties
Split Heels
Steatorrhea
Stress/Tension
Stroke (basal)
Tendon Pain Chronic
Tetany
Thrombocytosis (hyposplenism)
Thyroid Problems
Transaminase, elevated concentration = liver problem
Vasculitis
Vomiting
Weight Loss

Some Related Symptom Lists From Established Medical Sites:
(sources for much of the above list) A good, if short list from the University of Chicago Celiac Disease Program.
Main Presentations of Extraintestinal (or ‘Atypical’) Celiac Disease
· Dermatitis herpetiformis
· Permanent enamel hypoplasia
· Iron deficiency anemia that is resistant to oral iron therapy
· Short stature, delayed puberty
· Chronic hepatitis with hypertransaminasemia
· Primary biliary cirrhosis
· Arthritis
· Osteopenia/Osteoporosis
· Epilepsy with occipital calcifications
· Primary ataxia
· Psychiatric disorders
· Infertility

Celiac Features and Associated Conditions from The New England Journal of Medicine
COMMON FEATURES ASSOCIATED CONDITIONS
Adults Definite associations
Iron-deficiency anemia Dermatitis herpetiformis
Diarrhea IgA deficiency
LESS COMMON FEATURES Type 1 diabetes
Children Autoimmune thyroid disease
Diarrhea Sjögren’s syndrome
Failure to thrive Microscopic colitis
Abdominal distention Rheumatoid arthritis
General features Down’s syndrome
Short stature IgA nephropathy
Delayed puberty Possible associations
Gastrointestinal features Congenital heart disease
Recurrent aphthous stomatitis Recurrent pericarditis
Recurrent abdominal pain Sarcoidosis
Steatorrhea Cystic fibrosis
Extraintestinal features Fibrosing alveolitis
Folate-deficiency anemia Lung cavities
Osteopenia or osteoporosis Pulmonary hemosiderosis
Dental-enamel hypoplasia Inflammatory bowel disease
Vitamin K deficiency Autoimmune hepatitis
Hypertransaminasemia Primary biliary cirrhosis
Thrombocytosis (hyposplenism) Addison’s disease
Arthralgia or arthropathy Systemic lupus erythematosus
Polyneuropathy Vasculitis
Ataxia Polymyositis
Epilepsy (with or w/o cerebral calcification) Myasthenia gravis
Infertility Schizophrenia
Recurrent abortions COMPLICATIONS
Anxiety and depression Refractory sprue
Follicular keratosis Enteropathy-associated T-cell lymphoma
Alopecia Carcinoma of the oropharynx, esophagus, and small bowel
Ulcerative jejunoileitis
Collagenous sprue

Celiac Symptoms from Web MD:
· Diarrhea.
· Underweight
· Gas
· Delayed onset of puberty.
· Delayed growth.
· Problems with memory and concentration.
· Depression.
· Frequent respiratory infections.
· Anemia.
· Fatigue
· Bone problems.
· Female Reproductive system problems.

American Journal of Clinical Nutrition. The widening spectrum of celiac disease
Presentations of gluten-sensitive enteropathy
Gastrointestinal symptoms Nongastrointestinal symptoms
——————————————————————————–
Steatorrhea Dermatitis herpetiformis
Duodenal obstruction Infertility or fetal loss
Osmotic diarrhea Anemia
Elevated transaminase concentrations Dementia
Secretory diarrhea Folate or iron deficiency
Recurrent pancreatitis Spinocerebellar syndrome
Weight loss Neuropathy
Occult blood Tetany
Constipation Osteoporosis
Enteropathy-associated T cell lymphoma Arthralgia
Bloating Abdominal pain Developmentally synchronous dental enamel defects
Failure to thrive Fatigue
Vomiting Osteomalcia
Dyspepsia Seizures
Depression
Brittleness of diabetes control

Crohn’s Disease Symptoms from Web MD
● abdominal pain
● diarrhea
● Rectal bleeding
● weight loss
● Fever
● delayed development, stunted growth
● High white blood cell

Inflammatory Bowel Disease Symptoms from Web MD (Ulcerative colitis and Crohn’s disease)
● abdominal pain
● Diarrhea
● Constipation
● Loss of appetite.
● Fever
● Weight loss
● anemia
● Ulcers in the mouth.
● Nutritional deficiencies
● Bowel obstruction
● Bowel ulcers
● Small tears (fissures) in the anus.

Complications of Inflammatory Bowel Disease outside the digestive tract
● Joint pain
● eye problems
● Eye symptoms such as cataracts, ulcers on the cornea, inflammation of the iris and blood vessels (uveitis), and inflammation of the white part of the eyes (sclera). Eye problems occur in less than 10% of people who have IBD.
● skin rash
● Liver
● Urinary tract complications
● Delayed childhood Development
● Blood Clots
● Osteoporosis.

● Hypothyroidism
● fatigue
● weight gain
● constipation
● dry skin
● dry hair
● hair loss
● high cholesterol
● drastically reduced sex drive
● brain fog
● full-feeling neck
● swollen hands and feet
● muscle pain
● carpal tunnel syndrome
● tendonitis

Sjögren’s Syndrome
● Dry, gritty, sandy, or itchy feeling in your eyes
● A “filmy” sensation in your eyes that interferes with vision
● Thick, ropelike strands of dried mucus in your eyes when you wake up in the morning
● Redness and decreased tearing
● Bright lights may bother your eyes
● Inflamed eyelids (blepharitis)
● Eye fatigue
● Decreased amount of saliva
● Difficulty swallowing food without also drinking a liquid
● Abnormal sense of taste
● Sores (fissures) on the tongue and lips
● Numerous cavities and gum (periodontal) disease caused by rapid tooth decay
● Decreased sense of taste and smell
● Mouth may feel full of cotton
● Enlarged saliva glands under the chin (submandibular glands) and in front of the ears (parotid glands) that can be sore and tender.
● Exceptionally dry skin with decreased sweat production
● Skin rashes, bumps, and bruises that can be sensitive to light.
● Vaginal dryness, causing discomfort, itching, and painful intercourse.
● Increased fatigue
● A yeast infection in the mouth (thrush).
● Burning sensation (heartburn) in the chest or throat caused by abnormal backflow of acid and other digestive juices.
● Dry nose and throat, which can lead to sinus infections, bronchitis, and pneumonia
● Allergic reactions to medications, particularly to penicillin and sulfur compounds
● Joint and muscle pain
● Thyroid problems such as hypothyroidism or hyperthyroidism
● Nervous system problems, such as numbness or tingling in extremities, or peripheral neuropathies
● Cold, numb, painful fingers and hands (Raynaud’s phenomenon).
● Pain and difficulty with dentures, which may lead to dental restorations

Symptoms of Mania – the “highs” of bipolar disorder From WebMD
● Increased physical and mental activity and energy
● Heightened mood, exaggerated optimism and self-confidence
● Excessive irritability, aggressive behavior
● Decreased need for sleep without experiencing fatigue
● Grandiose delusions, inflated sense of self-importance
● Racing speech, racing thoughts, flight of ideas
● Impulsiveness, poor judgment, distractibility
● Reckless behavior
● In the most severe cases, delusions and hallucinations

Symptoms of depression – the “lows” of bipolar disorder From WebMD
● Prolonged sadness or unexplained crying spells
● Significant changes in appetite and sleep patterns
● Irritability, anger, worry, agitation, anxiety
● Pessimism, indifference
● Loss of energy, persistent lethargy
● Feelings of guilt, worthlessness
● Inability to concentrate, indecisiveness
● Inability to take pleasure in former interests, social withdrawal
● Unexplained aches and pains
● Recurring thoughts of death or suicide

“Be careful reading medical books. You might die of a mis-print.” — Mark Twain REFERENCE

  • Catassi C, Fabiani E, Ratsch IM, Coppa GV, Giorgi PL, Pierdomenico R. The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school-age subjects. Acta Paediatr Suppl 1996;412:29-35.
  • Hill I, Fasano A, Schwartz R, Counts D, Glock M, Horvath K. The prevalence of celiac disease in at risk groups of children in United States. Pediatr Res 2000;136:86-90.
  • Hoffenberg EJ, MacKenzie T, Barriga KJ, Eisenbarth GS, Bao F, Haas JE, Erlich H, Bugawan TT, Sokol RJ, Taki I, Norris JM,
  • Catassi C, Fasano A. New developments in childhood celiac disease. Curr Gastroenterol Rep 2002;4:238-243.
  • Barera G, Mora S, Brambilla P, Ricotti A, Menni L, Beccio S, Bianchi C. Body composition in children with celiac disease and the effects of a gluten-free diet: a prospective case-control study. Am J Clin Nutr 2000;72:71-75.
  • Labate A, Gambardella A, Messina D, Tammaro S, Le Piane E, Pirritano D. Silent celiac disease in patients with childhood localization-related epilepsies. Epilepsia 2001;42:1153-1155.
  • D’Amico MA, Holmes J, Stavropoulos SN, et al. Presentation of pediatric celiac disease in the United States: prominent effect of breastfeeding. Clin Pediatr (Phila) 2005;44:249-258.
  • Green PHR, Stavropoulos SN, Panagi SG, et al. Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol 2001;96:126-131.
  • Rampertab SD, Pooran N, Brar P, Singh P, Green PH. Trends in the presentation of celiac disease. Am J Med 2006;119(4):355.e9-355.e14. Pavone L, Fiumara A, Bottaro G, Mazzone D, Coleman M. Autism and celiac disease: failure to validate the hypothesis that a link
  • Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology 2001;120:636-651.
  • Ventura A, Magazzu G, Greco L, SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. Gastroenterology 1999;117:297-303.
  • Larizza D, Calcaterra V, De Giacomo C, De Silvestri A, Asti M, Badulli C, Autelli M, Coslovich E, Martinetti M. Celiac disease in children with autoimmune thyroid disease. J Pediatr 2001;139:738-740.
  • Catassi C, Fasano A. New developments in childhood celiac disease. Curr Gastroenterol Rep 2002;4:238-243.
  • National Institutes of Health Consensus Conference on Celiac Disease. Available: www.consensus.nih.gov/cons/118/118cdc_intro.htm.
  • Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, Hoffenberg EJ, Horvath K, Murray JA, Pivor M, Seidman EG. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2005;40:1-19.

www.celiacclinic.com

Provided By: CELIAC CLINIC ONLINE Supported By: GRoW UP CLINIC JAKARTA Yudhasmara Foundation Address: *** Jl Taman Bendungan Asahan 5 Bendungan Hilir Jakarta Pusat 10210, phone (021) 5703646 – 085101466102 – 085100466103 ***MENTENG SQUARE Jl Matraman 30 Jakarta Pusat 10430, Phone (021) 2961425208131592-2012 – 08131592-2013 – 08131592-2012 email : judarwanto@gmail.com http://growupclinic.com Facebook: http://www.facebook.com/GrowUpClinic Twitter: @growupclinic Professional Healthcare Provider “GRoW UP CLINIC” Dr Narulita Dewi SpKFR, Physical Medicine & Rehabilitation curriculum vitae HP 085777227790 PIN BB 235CF967 Clinical – Editor in Chief : Dr Widodo Judarwanto, Pediatrician email : judarwanto@gmail.com Mobile Phone O8567805533 PIN BBM 76211048 Komunikasi dan Konsultasi online : twitter @widojudarwanto facebook dr Widodo Judarwanto, pediatrician Komunikasi dan Konsultasi Online Alergi Anak : Allergy Clinic Online Komunikasi dan Konsultasi Online Sulit makan dan Gangguan Berat Badan : Picky Eaters Clinic Komunikasi Profesional Pediatric: Indonesia Pediatrician Online
Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider

Copyright © 2015, Celiac Clinic Online, Information Education Network. All rights reserved
Iklan

Tinggalkan Balasan

Isikan data di bawah atau klik salah satu ikon untuk log in:

Logo WordPress.com

You are commenting using your WordPress.com account. Logout / Ubah )

Gambar Twitter

You are commenting using your Twitter account. Logout / Ubah )

Foto Facebook

You are commenting using your Facebook account. Logout / Ubah )

Foto Google+

You are commenting using your Google+ account. Logout / Ubah )

Connecting to %s