Extra-intestinal Manifestations of Celiac Disease: Effectiveness of the Gluten Free Diet.

OBJECTIVE: To evaluate the effectiveness of the GFD on extra-intestinal symptoms in pediatric and adult celiac populations at the University of Chicago (UofC).

METHODS: We conducted a retrospective chart review of the UofC Celiac Center clinic charts from January 2002 to October 2014. Demographics, serologic testing, intestinal biopsies, and extra-intestinal symptoms at presentation, 12, 24, and greater than 24 months were recorded. Extra-intestinal symptoms included: abnormal liver enzymes, arthralgia/arthritis, dermatitis herpetiformis (DH), alopecia, fatigue, headache, anemia, stomatitis, myalgias, psychiatric disorders, rashes, seizures, neuropathy, short stature, delayed puberty, osteoporosis and infertility.

RESULTS: A total of 737 patients with biopsy confirmed CeD or skin biopsy confirmed DH were included. Patients lost to follow up, or with insufficient data were excluded leaving 328 patients (157 pediatrics < 18 years). For pediatrics, the female to male ratio was 2:1 and the mean age at diagnosis was 8.9 years old. For adults, 4:1 and 40.6 years old. Extra-intestinal symptom rates were similar in children (60%) and adults (62%). Short stature (33%), fatigue (28%) and headache (20%) were most common in children. Iron deficiency anemia (48%), fatigue (37%) and headache/psychiatric disorders (24%) in adults. Children had faster/higher rates of symptom resolution compared to adults. Twenty-eight percent of children with unresolved short stature on a GFD were found to have other comorbidities.

CONCLUSIONS: Children and adults with CeD have similar rates of extra-intestinal manifestations. In children short stature, fatigue and headache were most common while anemia, fatigue and headache/psychiatric disorders were most common in adults. Children on a strict GFD showed faster and higher rates of symptom resolution as compared to adults. Unresponsive children with short stature must be assessed for comorbidities.