Celiac Disease : Complications, Dermatitis Herpetiformis

by National Institute of Health

(Page 3 of 3)

What are the complications of celiac disease?

Damage to the small intestine and the resulting nutrient absorption problems put a person with celiac disease at risk for malnutrition and anemia as well as several diseases and health problems.

Lymphoma and adenocarcinoma are cancers that can develop in the intestine.

Osteoporosis is a condition in which the bones become weak, brittle, and prone to breaking. Poor calcium absorption contributes to osteoporosis.

Miscarriage and congenital malformation of the baby, such as neural tube defects, are risks for pregnant women with untreated celiac disease because of nutrient absorption problems.

Short stature refers to being significantly under-the-average height. Short stature results when childhood celiac disease prevents nutrient absorption during the years when nutrition is critical to a child's normal growth and development. Children who are diagnosed and treated before their growth stops may have a catch-up period.

How common is celiac disease?

Data on the prevalence of celiac disease is spotty. In Italy, about 1 in 250 people and in Ireland about 1 in 300 people have celiac disease. Recent studies have shown that it may be more common in Africa, South America, and Asia than previously believed.

Until recently, celiac disease was thought to be uncommon in the United States. However, studies have shown that celiac disease is very common. Recent findings estimate about 2 million people in the United States have celiac disease, or about 1 in 133 people. Among people who have a first-degree relative diagnosed with celiac disease, as many as 1 in 22 people may have the disease.

Celiac disease could be under diagnosed in the United States for a number of reasons including:

• Celiac symptoms can be attributed to other problems.
• Many doctors are not knowledgeable about the disease.
• Only a small number of U.S. laboratories are experienced and skilled in testing for celiac disease.

More research is needed to learn the true prevalence of celiac disease among Americans.

Points to Remember

• People with celiac disease cannot tolerate gluten, a protein in wheat, rye, barley, and possibly oats.
• Celiac disease damages the small intestine and interferes with nutrient absorption.
• Without treatment, people with celiac disease can develop complications like cancer, osteoporosis, anemia, and seizures.
• A person with celiac disease may or may not have symptoms.
• Diagnosis involves blood tests and a biopsy of the small intestine.
• Since celiac disease is hereditary, family members of a person with celiac disease may wish to be tested.
• Celiac disease is treated by eliminating all gluten from the diet. The gluten-free diet is a lifetime requirement.
• A dietitian can teach a person with celiac disease food selection, label reading, and other strategies to help manage the disease.

Diseases Linked to Celiac Disease

People with celiac disease tend to have other autoimmune diseases. The connection between celiac disease and these diseases may be genetic. These diseases include

• thyroid disease
• systemic lupus erythematosus
• type 1 diabetes
• liver disease
• collagen vascular disease
• rheumatoid arthritis
• Sjögren's syndrome

Dermatitis Herpetiformis

Dermatitis herpetiformis (DH) is a severe itchy, blistering manifestation of celiac disease. The rash usually occurs on the elbows, knees, and buttocks. Not all people with celiac disease develop dermatitis herpetiformis. Unlike other forms of celiac disease, the range of intestinal abnormalities in DH is highly variable, from minimal to severe. Only about 20 percent of people with DH have intestinal symptoms of celiac disease.

To diagnose DH, the doctor will test the person's blood for autoantibodies related to celiac disease and will biopsy the person's skin. If the antibody tests are positive and the skin biopsy has the typical findings of DH, patients do not need to have an intestinal biopsy. Both the skin disease and the intestinal disease respond to gluten-free diet and recur if gluten is added back into diet. In addition, the rash symptoms can be controlled with medications such as dapsone (4',4'diamino-diphenylsuphone). However, dapsone does not treat the intestinal condition and people with DH should also maintain a gluten-free diet.

Hope Through Research

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducts and supports research on celiac disease. NIDDK-supported researchers are studying the genetic and environmental causes of celiac disease. In addition, researchers are studying the substances found in gluten that are believed to be responsible for the destruction of the immune system function, as happens in celiac disease. They are engineering enzymes designed to destroy these immunotoxic peptides. Researchers are also developing educational materials for standardized medical training to raise awareness among healthcare providers. The hope is that increased understanding and awareness will lead to earlier diagnosis and treatment of celiac disease.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.