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By  Christopher Cutler, M.D.

Many people with celiac disease present with classic gastrointestinal symptoms such as diarrhea, gas, bloating, abdominal pain, and weight loss.  However, other people have no GI complaints and may present with non-specific symptoms, making the diagnosis of celiac disease very difficult.  The following is a list of some conditions which, if unexplained by other diseases, should raise the suspicion of celiac disease:

Iron deficiency anemia – Celiac disease may lead to a reduced absorption of iron.  It may also cause malabsorption of other nutrients required for red blood cell production, including vitamin B12 and folate.  Typical symptoms of anemia include fatigue, weakness, and poor exercise tolerance.

Elevated liver enzymes – Many patients with chronically abnormal liver enzymes undergo an extensive evaluation with no cause found.  Celiac disease should be considered.

Neurologic or psychiatric symptoms – Some patients with celiac disease have been found to have significant structural and functional brain deficits on MRI.  These patients may experience unexplained headaches, impaired balance or coordination, peripheral neuropathy (burning, tingling, or numbness in the hands and feet), seizures, depression, or anxiety.

Weakening of the bones – Celiac disease can lead to malabsorption of vitamin D.  Patients with celiac disease should be screened for osteoporosis.

Dermatitis herpetiformis – This is a skin condition which causes itchy fluid-filled bumps, most commonly found on the elbows, forearms, scalp, back, and buttocks.  Approximately 85% of people with dermatitis herpetiformis have underlying celiac disease.

Menstrual and reproductive issues – Who would think to blame these issues on a gastrointestinal disease?  But women with celiac disease may have a later onset of menstrual periods, earlier menopause, infertility, recurrent miscarriages, pre-term deliveries, and low birth weight infants.

Arthritis – There is an increased prevalence of osteoarthritis in people with celiac disease.

Oral disease – Patients who present with discolored teeth, enamel loss, or a painful tongue, unexplained by other diseases, should be tested for celiac disease.

Miscellaneous – Celiac disease has also been associated with type 1 diabetes, autoimmune thyroid disease, cardiomyopathy, and pancreatitis.

If you have any of the above conditions which cannot be explained, I strongly encourage you to follow up with the doctors at Granite Peaks Gastroenterology to be tested for celiac disease.  A simple blood test is all it takes.

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