Page 4 - 04- Celiac Disease

Weight loss, weakness, fatigue
Delayed puberty
Iron deficiency anemia
Recurrent aphthous stomatitis
Dental enamel hyperplasia
Muscle cramps
Bone or joint pain
Anxiety, depression
Tingling numbness in hands, feet
Migraines
In children, malabsorption may manifest as failure to thrive, short stature, or chronic fatigue
(5).
Anorexia
Constipation or encopresis
PHYSICAL EXAM
Physical examination is often normal. Findings include:
Orthostatic hypotension
Peripheral edema
Oropharynx: aphthous stomatitis, glossitis, cheilosis
Skin: dermatitis herpetiformis (symmetric erythematous papules and blisters on elbows, knees,
buttocks, and back), signs of anemia
Abdomen: distention
DIFFERENTIAL DIAGNOSIS
Gluten allergy–type II allergic reaction with signs of anaphylaxis
Nonceliac gluten sensitivity—GI symptoms and/or systemic symptoms improved by GFD but

without biomarkers characteristic of celiac disease
Short bowel syndrome, small intestinal bacterial overgrowth
Lactose intolerance; dyspepsia
Gastroesophageal reflux disease (GERD)
Pancreatic exocrine insufficiency
Crohn disease; Whipple disease
Tropical sprue; hypogammaglobulinemia
Intestinal lymphoma; microscopic colitis
Autoimmune enteropathy; HIV enteropathy
Acute enteritis; radiation enteritis
Eosinophilic gastroenteritis; giardiasis
IBS
DIAGNOSTIC TESTS & INTERPRETATION
Initial Tests (lab, imaging
Tissue biopsy is the gold standard for diagnosis.
Do not base diagnosis solely on serology in adults. Patients with symptoms highly suggestive
of celiac disease or those with positive serologies should undergo endoscopy for small bowel

biopsy while on a gluten-containing diet.
Biopsy and histologic examination of duodenal bulb during routine upper endoscopy increases