Extraintestinal manifestations of coeliac disease

• Published in: Nature reviews. Gastroenterology & hepatology Vol. 12; no. 10; pp. 561 - 571
• Main Authors: Leffler, Daniel A., Green, Peter H. R., Fasano, Alessio
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-10-2015; Nature Publishing Group
• Subjects: 692/1807/1693; 692/1807/1812; 692/698/2741; 692/699/1503/1702/1357; 692/699/249/1313; Anemia - etiology; Biomedicine; Care and treatment; Celiac disease; Celiac Disease - complications; Celiac Disease - physiopathology; Complications and side effects; Gastroenterology; Hepatology; Humans; Medicine & Public Health; Mental Disorders - etiology; Musculoskeletal Diseases - etiology; Nervous System Diseases - etiology; review-article; Skin Diseases - etiology
• ISSN: 1759-5045; 1759-5053
• DOI: 10.1038/nrgastro.2015.131

Key Points
Coeliac disease is often accompanied by extraintestinal manifestations, which can be the result of aberrant immune responses but also malabsorption
These concurrent conditions can affect various systems and organs, and include manifestations in the skin, musculoskeletal and central nervous system
Anaemia, osteoporosis, dermatitis herpetiformis and gluten ataxia are among the most commonly seen characteristics
In the paediatric population, coeliac disease can lead to severe growth disorders, such as short stature and delayed puberty due to hypogonadism
Coeliac disease is common, but remains under-diagnosed, partly because it can present with extraintestinal symptoms that do not immediately enable an accurate diagnosis of the underlying disease. In this Review, Leffler and colleagues discuss the most common extraintestinal manifestations, including dermatitis herpetiformis, gluten ataxia, anaemia, osteoporosis and others, to raise additional awareness among clinicians.
Coeliac disease is a common disorder that can arise at any age and typically presents with a broad spectrum of symptoms. The disease is thought to be underdiagnosed, in part owing to the fact that coeliac disease is often characterized by associated conditions and extraintestinal manifestations that can misdirect and impede diagnosis. Some of these manifestations are direct consequences of autoimmunity, such as dermatitis herpetiformis or gluten ataxia, whereas others are indirectly related to inflammation and/or malabsorption including anaemia, osteoporosis, short stature and delayed puberty. Any organ from the central nervous system to joints, liver or teeth can be affected. In some cases, extraintestinal symptoms are the only clinical manifestations of coeliac disease or occur in conjunction with diarrhoea and malabsorptive symptoms. An increased awareness among medical practitioners of the variety of extraintestinal manifestations of coeliac disease is essential to improve diagnosis and treatment.