Celiac Disease

  • C. S. Pitchumoni
  • C. S. Pitchumoni
  • C. S. Pitchumoni
  • Nancy Chen


Once believed to be a pediatric disease, celiac disease is now recognized to emerge at any age; it has a high prevalence in older adults, although the manifestations are subtle. The disease is characterized by multisystem involvement, with many atypical manifestations. The prevalence of CD is steadily increasing the world over. In the older adult, CD may present with anemia mostly of the iron deficiency type, osteoporosis, obesity, and rarely neurological manifestations or in association with other autoimmune disorders. The diagnosis is established by serum antibody, small bowel histological abnormality, and response to a gluten-free diet. In untreated CD patients, there may be modest increase in small bowel lymphoma.


Celiac Disease Primary Biliary Cirrhosis Villous Atrophy Celiac Disease Patient Dermatitis Herpetiformis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Rubio-Tapia A, Murray JA. Celiac disease. Curr Opin Gastroenterol. 2010;26:116–22.PubMedGoogle Scholar
  2. 2.
    Crowe SE. Celiac disease. Ann Intern Med. 2011;154:ITC5-1.Google Scholar
  3. 3.
    Johnson MW, Ellis HJ, Asante MA, Ciclitira PJ. Celiac disease in the elderly. Nat Clin Pract Gastroenterol Hepatol. 2008;5:697–706.PubMedGoogle Scholar
  4. 4.
    Gasbarrini G, Miele L, Corazza GR, Gasbarrini A. When was celiac disease born?: the Italian case from the archeologic site of Cosa. J Clin Gastroenterol. 2010;44:502–3.PubMedGoogle Scholar
  5. 5.
    Losowsky MS. A history of coeliac disease. Dig Dis. 2008;26:112–20.PubMedGoogle Scholar
  6. 6.
    Dube C, Rostom A, Sy R, et al. The prevalence of celiac disease in average-risk and at-risk Western European populations: a systematic review. Gastroenterology. 2005;128:S57–67.PubMedGoogle Scholar
  7. 7.
    Cummins AG, Roberts-Thomson IC. Prevalence of celiac disease in the Asia-Pacific region. J Gastroenterol Hepatol. 2009;24:1347–51.PubMedGoogle Scholar
  8. 8.
    Catassi C, Ratsch IM, Gandolfi L, et al. Why is coeliac disease endemic in the people of the Sahara? Lancet. 1999;354:647–8.PubMedGoogle Scholar
  9. 9.
    Sood A, Midha V, Sood N, et al. Prevalence of celiac disease among school children in Punjab, North India. J Gastroenterol Hepatol. 2006;21:1622–5.PubMedGoogle Scholar
  10. 10.
    Bhattacharya M, Dubey AP, Mathur NB. Prevalence of celiac disease in north Indian children. Indian Pediatr. 2009;46:415–7.PubMedGoogle Scholar
  11. 11.
    Gomez JC, Selvaggio GS, Viola M, et al. Prevalence of celiac disease in Argentina: screening of an adult population in the La Plata area. Am J Gastroenterol. 2001;96:2700–4.PubMedGoogle Scholar
  12. 12.
    Pereira MA, Ortiz-Agostinho CL, Nishitokukado I, et al. Prevalence of celiac disease in an urban area of Brazil with predominantly European ancestry. World J Gastroenterol. 2006;12:6546–50.PubMedGoogle Scholar
  13. 13.
    Remes-Troche JM, Ramirez-Iglesias MT, Rubio-Tapia A, et al. Celiac disease could be a frequent disease in Mexico: prevalence of tissue transglutaminase antibody in healthy blood donors. J Clin Gastroenterol. 2006;40:697–700.PubMedGoogle Scholar
  14. 14.
    Katz KD, Rashtak S, Lahr BD, et al. Screening for celiac disease in a North American population: sequential serology and gastrointestinal symptoms. Am J Gastroenterol. 2011;106(7):1333–9.PubMedGoogle Scholar
  15. 15.
    Virta LJ, Kaukinen K, Collin P. Incidence and prevalence of diagnosed coeliac disease in Finland: results of effective case finding in adults. Scand J Gastroenterol. 2009;44:933–8.PubMedGoogle Scholar
  16. 16.
    Barton SH, Kelly DG, Murray JA. Nutritional deficiencies in celiac disease. Gastroenterol Clin North Am. 2007;36:93–108; vi.Google Scholar
  17. 17.
    Mustalahti K, Catassi C, Reunanen A, et al. The prevalence of celiac disease in Europe: results of a centralized, international mass screening project. Ann Med. 2010;42:587–95.PubMedGoogle Scholar
  18. 18.
    Makharia GK, Verma AK, Amarchand R, et al. Prevalence of celiac disease in the northern part of India: a community based study. J Gastroenterol Hepatol. 2011;26:894–900.PubMedGoogle Scholar
  19. 19.
    Agostoni C, Decsi T, Fewtrell M, et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2008;46:99–110.PubMedGoogle Scholar
  20. 20.
    Myleus A, Ivarsson A, Webb C, et al. Celiac disease revealed in 3% of Swedish 12-year-olds born during an epidemic. J Pediatr Gastroenterol Nutr. 2009;49:170–6.PubMedGoogle Scholar
  21. 21.
    Kondrashova A, Mustalahti K, Kaukinen K, et al. Lower economic status and inferior hygienic environment may protect against celiac disease. Ann Med. 2008;40:223–31.PubMedGoogle Scholar
  22. 22.
    Bardella MT, Trovato C, Cesana BM, et al. Serological markers for coeliac disease: is it time to change? Dig Liver Dis. 2001;33:426–31.PubMedGoogle Scholar
  23. 23.
    Vilppula A, Collin P, Maki M, et al. Undetected coeliac disease in the elderly: a biopsy-proven population-based study. Dig Liver Dis. 2008;40:809–13.PubMedGoogle Scholar
  24. 24.
    Vilppula A, Kaukinen K, Luostarinen L, et al. Increasing prevalence and high incidence of celiac disease in elderly people: a population-based study. BMC Gastroenterol. 2009;9:49.PubMedGoogle Scholar
  25. 25.
    Ludvigsson JF, Montgomery SM, Ekbom A, Brandt L, Granath F. Small-intestinal histopathology and mortality risk in celiac disease. JAMA. 2009;302:1171–8.PubMedGoogle Scholar
  26. 26.
    Beaumont DM, Mian MS. Coeliac disease in old age: ‘a catch in the rye’. Age Ageing. 1998;27:535–8.PubMedGoogle Scholar
  27. 27.
    Feighery C, Weir DG, Whelan A, et al. Diagnosis of gluten-sensitive enteropathy: is exclusive reliance on histology appropriate? Eur J Gastroenterol Hepatol. 1998;10:919–25.PubMedGoogle Scholar
  28. 28.
    Ferguson A, Arranz E, O’Mahony S. Clinical and pathological spectrum of coeliac disease—active, silent, latent, potential. Gut. 1993;34:150–1.PubMedGoogle Scholar
  29. 29.
    Swinson CM, Levi AJ. Is coeliac disease underdiagnosed? Br Med J. 1980;281:1258–60.PubMedGoogle Scholar
  30. 30.
    Campbell CB, Roberts RK, Cowen AE. The changing clinical presentation of coeliac disease in adults. Med J Aust. 1977;1:89–93.PubMedGoogle Scholar
  31. 31.
    Hankey GL, Holmes GK. Coeliac disease in the elderly. Gut. 1994;35:65–7.PubMedGoogle Scholar
  32. 32.
    Zipser RD, Patel S, Yahya KZ, Baisch DW, Monarch E. Presentations of adult celiac disease in a nationwide patient support group. Dig Dis Sci. 2003;48:761–4.PubMedGoogle Scholar
  33. 33.
    Tursi A, Elisei W, Giorgetti GM, et al. Prevalence of celiac disease and symptoms in relatives of patients with celiac disease. Eur Rev Med Pharmacol Sci. 2010;14:567–72.PubMedGoogle Scholar
  34. 34.
    Sollid LM, Markussen G, Ek J, et al. Evidence for a primary association of celiac disease to a particular HLA-DQ alpha/beta heterodimer. J Exp Med. 1989;169:345–50.PubMedGoogle Scholar
  35. 35.
    Rubio-Tapia A, Van Dyke CT, Lahr BD, et al. Predictors of family risk for celiac disease: a population-based study. Clin Gastroenterol Hepatol. 2008;6:983–7.PubMedGoogle Scholar
  36. 36.
    Gudjonsdottir AH, Nilsson S, Ek J, Kristiansson B, Ascher H. The risk of celiac disease in 107 families with at least two affected siblings. J Pediatr Gastroenterol Nutr. 2004;38:338–42.PubMedGoogle Scholar
  37. 37.
    Greco L, Romino R, Coto I, et al. The first large population based twin study of coeliac disease. Gut. 2002;50:624–8.PubMedGoogle Scholar
  38. 38.
    Cleo J, Libonati DMC. Recognizing celiac disease signs, symptoms, associated disorders & complications. Fort Washington: Gluten Free Works Publishing; 2007.Google Scholar
  39. 39.
    Green PH. The many faces of celiac disease: clinical presentation of celiac disease in the adult population. Gastroenterology. 2005;128:S74–8.PubMedGoogle Scholar
  40. 40.
    Alaedini A, Green PH. Narrative review: celiac disease: understanding a complex autoimmune disorder. Ann Intern Med. 2005;142:289–98.PubMedGoogle Scholar
  41. 41.
    Chand N, Mihas AA. Celiac disease: current concepts in diagnosis and treatment. J Clin Gastroenterol. 2006;40:3–14.PubMedGoogle Scholar
  42. 42.
    Farrell RJ, Kelly CP. Celiac sprue. N Engl J Med. 2002;346:180–8.PubMedGoogle Scholar
  43. 43.
    Bardella MT, Fraquelli M, Quatrini M, et al. Prevalence of hypertransaminasemia in adult celiac patients and effect of gluten-free diet. Hepatology. 1995;22:833–6.PubMedGoogle Scholar
  44. 44.
    Kaukinen K, Halme L, Collin P, et al. Celiac disease in patients with severe liver disease: gluten-free diet may reverse hepatic ­failure. Gastroenterology. 2002;122:881–8.PubMedGoogle Scholar
  45. 45.
    Rampertab SD, Pooran N, Brar P, et al. Trends in the presentation of celiac disease. Am J Med. 2006;119(355):e9–14.PubMedGoogle Scholar
  46. 46.
    Jadallah KA, Khader YS. Celiac disease in patients with presumed irritable bowel syndrome: a case-finding study. World J Gastroenterol. 2009;15:5321–5.PubMedGoogle Scholar
  47. 47.
    Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003;163:286–92.PubMedGoogle Scholar
  48. 48.
    Tommasini A, Not T, Kiren V, et al. Mass screening for coeliac disease using antihuman transglutaminase antibody assay. Arch Dis Child. 2004;89:512–5.PubMedGoogle Scholar
  49. 49.
    Kaukinen K, Collin P, Maki M. Latent coeliac disease or coeliac disease beyond villous atrophy? Gut. 2007;56:1339–40.PubMedGoogle Scholar
  50. 50.
    Collin P, Huhtala H, Virta L, et al. Diagnosis of celiac disease in clinical practice: physician’s alertness to the condition essential. J Clin Gastroenterol. 2007;41:152–6.PubMedGoogle Scholar
  51. 51.
    Marmouz F. Adult coeliac disease. Eur Ann Allergy Clin Immunol. 2007;39:23–5.PubMedGoogle Scholar
  52. 52.
    Mukherjee R, Egbuna I, Brar P, et al. Celiac disease: similar presentations in the elderly and young adults. Dig Dis Sci. 2010;55:3147–53.PubMedGoogle Scholar
  53. 53.
    Harper JW, Holleran SF, Ramakrishnan R, et al. Anemia in celiac disease is multifactorial in etiology. Am J Hematol. 2007;82:996–1000.PubMedGoogle Scholar
  54. 54.
    Carroccio A, Iannitto E, Cavataio F, et al. Sideropenic anemia and celiac disease: one study, two points of view. Dig Dis Sci. 1998;43:673–8.PubMedGoogle Scholar
  55. 55.
    Arnason JA, Gudjonsson H, Freysdottir J, et al. Do adults with high gliadin antibody concentrations have subclinical gluten intolerance? Gut. 1992;33:194–7.PubMedGoogle Scholar
  56. 56.
    Bergamaschi G, Markopoulos K, Albertini R, et al. Anemia of chronic disease and defective erythropoietin production in patients with celiac disease. Haematologica. 2008;93:1785–91.PubMedGoogle Scholar
  57. 57.
    Zamani F, Mohamadnejad M, Shakeri R, et al. Gluten sensitive enteropathy in patients with iron deficiency anemia of unknown origin. World J Gastroenterol. 2008;14:7381–5.PubMedGoogle Scholar
  58. 58.
    Mangione RA. Celiac disease and osteoporosis. Am J Health Syst Pharm. 2008;65:1601; author reply 2.Google Scholar
  59. 59.
    Meyer D, Stavropolous S, Diamond B, et al. Osteoporosis in a North American adult population with celiac disease. Am J Gastroenterol. 2001;96:112–9.PubMedGoogle Scholar
  60. 60.
    Ludvigsson JF, Michaelsson K, Ekbom A, Montgomery SM. Coeliac disease and the risk of fractures—a general population-based cohort study. Aliment Pharmacol Ther. 2007;25:273–85.PubMedGoogle Scholar
  61. 61.
    Vasquez H, Mazure R, Gonzalez D, et al. Risk of fractures in celiac disease patients: a cross-sectional, case-control study. Am J Gastroenterol. 2000;95:183–9.PubMedGoogle Scholar
  62. 62.
    Fickling WE, McFarlane XA, Bhalla AK, Robertson DA. The clinical impact of metabolic bone disease in coeliac disease. Postgrad Med J. 2001;77:33–6.PubMedGoogle Scholar
  63. 63.
    Thomason K, West J, Logan RF, et al. Fracture experience of patients with coeliac disease: a population based survey. Gut. 2003;52:518–22.PubMedGoogle Scholar
  64. 64.
    West J, Logan RF, Card TR, et al. Fracture risk in people with celiac disease: a population-based cohort study. Gastroenterology. 2003;125:429–36.PubMedGoogle Scholar
  65. 65.
    Mustalahti K, Collin P, Sievanen H, et al. Osteopenia in patients with clinically silent coeliac disease warrants screening. Lancet. 1999;354:744–5.PubMedGoogle Scholar
  66. 66.
    Kurppa K, Collin P, Sievanen H, et al. Gastrointestinal symptoms, quality of life and bone mineral density in mild enteropathic coeliac disease: a prospective clinical trial. Scand J Gastroenterol. 2010;45:305–14.PubMedGoogle Scholar
  67. 67.
    Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology. 2001;120:636–51.PubMedGoogle Scholar
  68. 68.
    Sategna-Guidetti C, Grosso SB, Grosso S, et al. The effects of 1-year gluten withdrawal on bone mass, bone metabolism and nutritional status in newly-diagnosed adult coeliac disease patients. Aliment Pharmacol Ther. 2000;14:35–43.PubMedGoogle Scholar
  69. 69.
    Bolin T, Bare M, Caplan G, Daniells S, Holyday M. Malabsorption may contribute to malnutrition in the elderly. Nutrition. 2010;26:852–3.PubMedGoogle Scholar
  70. 70.
    Alwitry A. Vitamin A deficiency in coeliac disease. Br J Ophthalmol. 2000;84:1079–80.PubMedGoogle Scholar
  71. 71.
    Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clin Proc. 2003;78:1457–9.PubMedGoogle Scholar
  72. 72.
    Molteni N, Bardella MT, Vezzoli G, et al. Intestinal calcium absorption as shown by stable strontium test in celiac disease before and after gluten-free diet. Am J Gastroenterol. 1995;90:2025–8.PubMedGoogle Scholar
  73. 73.
    Colston KW, Mackay AG, Finlayson C, et al. Localisation of vitamin D receptor in normal human duodenum and in patients with coeliac disease. Gut. 1994;35:1219–25.PubMedGoogle Scholar
  74. 74.
    Cavallaro R, Iovino P, Castiglione F, et al. Prevalence and clinical associations of prolonged prothrombin time in adult untreated coeliac disease. Eur J Gastroenterol Hepatol. 2004;16:219–23.PubMedGoogle Scholar
  75. 75.
    Scholmerich J, Wietholtz H, Buchsel R, et al. [Zinc and vitamin A deficiency in gastrointestinal diseases]. Leber Magen Darm. 1984;14:288–95.PubMedGoogle Scholar
  76. 76.
    Jameson S, Hellsing K, Magnusson S. Copper malabsorption in coeliac disease. Sci Total Environ. 1985;42:29–36.PubMedGoogle Scholar
  77. 77.
    Jamma S, Rubio-Tapia A, Kelly CP, et al. Celiac crisis is a rare but serious complication of celiac disease in adults. Clin Gastroenterol Hepatol. 2010;8:587–90.PubMedGoogle Scholar
  78. 78.
    Parry J, Acharya C. Celiac crisis in an older man. J Am Geriatr Soc. 2010;58:1818–9.PubMedGoogle Scholar
  79. 79.
    Dickey W, Kearney N. Overweight in celiac disease: prevalence, clinical characteristics, and effect of a gluten-free diet. Am J Gastroenterol. 2006;101:2356–9.PubMedGoogle Scholar
  80. 80.
    Owen DA, Thorlakson TK, Walli JE. Celiac disease in a patient with morbid obesity. Arch Intern Med. 1980;140:1380–1.PubMedGoogle Scholar
  81. 81.
    Semeraro LA, Barwick KW, Gryboski JD. Obesity in celiac sprue. J Clin Gastroenterol. 1986;8:177–80.PubMedGoogle Scholar
  82. 82.
    Cheng J, Brar PS, Lee AR, Green PH. Body mass index in celiac disease: beneficial effect of a gluten-free diet. J Clin Gastroenterol. 2010;44:267–71.PubMedGoogle Scholar
  83. 83.
    See J, Murray JA. Gluten-free diet: the medical and nutrition management of celiac disease. Nutr Clin Pract. 2006;21:1–15.PubMedGoogle Scholar
  84. 84.
    Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006;355:763–78.PubMedGoogle Scholar
  85. 85.
    Brar P, Kwon GY, Holleran S, et al. Change in lipid profile in celiac disease: beneficial effect of gluten-free diet. Am J Med. 2006;119:786–90.PubMedGoogle Scholar
  86. 86.
    West J, Logan RF, Card TR, et al. Risk of vascular disease in adults with diagnosed coeliac disease: a population-based study. Aliment Pharmacol Ther. 2004;20:73–9.PubMedGoogle Scholar
  87. 87.
    West J, Logan RF, Smith CJ, et al. Malignancy and mortality in people with coeliac disease: population based cohort study. BMJ. 2004;329:716–9.PubMedGoogle Scholar
  88. 88.
    Carroccio A, Iacono G, Montalto G, et al. Exocrine pancreatic function in children with coeliac disease before and after a gluten free diet. Gut. 1991;32:796–9.PubMedGoogle Scholar
  89. 89.
    Carroccio A, Iacono G, Lerro P, et al. Role of pancreatic impairment in growth recovery during gluten-free diet in childhood celiac disease. Gastroenterology. 1997;112:1839–44.PubMedGoogle Scholar
  90. 90.
    Regan PT, DiMagno EP. Exocrine pancreatic insufficiency in celiac sprue: a cause of treatment failure. Gastroenterology. 1980;78:484–7.PubMedGoogle Scholar
  91. 91.
    Pitchumoni CS, Thomas E, Balthazar E, Sherling B. Chronic calcific pancreatitis in association with celiac disease. Am J Gastroenterol. 1977;68:358–61.PubMedGoogle Scholar
  92. 92.
    Nanda R, Anand BS. Celiac disease and tropical calcific pancreatitis. Am J Gastroenterol. 1993;88:1790–2.PubMedGoogle Scholar
  93. 93.
    Arya S, Rana SS, Sinha SK, Nagi B, Bhasin DK. Celiac disease and chronic calcific pancreatitis with pancreas divisum. Gastrointest Endosc. 2006;63:1080–1.PubMedGoogle Scholar
  94. 94.
    Ludvigsson JF, Montgomery SM, Ekbom A. Risk of pancreatitis in 14,000 individuals with celiac disease. Clin Gastroenterol Hepatol. 2007;5:1347–53.PubMedGoogle Scholar
  95. 95.
    Pitchumoni CS. Pancreas in primary malnutrition disorders. Am J Clin Nutr. 1973;26:374–9.PubMedGoogle Scholar
  96. 96.
    Nordgren L, von Scheele C. Hepatic and pancreatic dysfunction in anorexia nervosa: a report of two cases. Biol Psychiatry. 1977;12:681–6.PubMedGoogle Scholar
  97. 97.
    Cox KL, Cannon RA, Ament ME, et al. Biochemical and ultrasonic abnormalities of the pancreas in anorexia nervosa. Dig Dis Sci. 1983;28:225–9.PubMedGoogle Scholar
  98. 98.
    Patel RS, Johlin Jr FC, Murray JA. Celiac disease and recurrent pancreatitis. Gastrointest Endosc. 1999;50:823–7.PubMedGoogle Scholar
  99. 99.
    Evans KE, Leeds JS, Morley S, Sanders DS. Pancreatic insufficiency in adult celiac disease: do patients require long-term enzyme supplementation? Dig Dis Sci. 2010;55:2999–3004.PubMedGoogle Scholar
  100. 100.
    Rashtak S, Marietta EV, Murray JA. Celiac sprue: a unique autoimmune disorder. Expert Rev Clin Immunol. 2009;5:593–604.PubMedGoogle Scholar
  101. 101.
    Buysschaert M, Tomasi JP, Hermans MP. Prospective screening for biopsy proven coeliac disease, autoimmunity and malabsorption markers in Belgian subjects with Type 1 diabetes. Diabet Med. 2005;22:889–92.PubMedGoogle Scholar
  102. 102.
    Mahmud FH, Murray JA, Kudva YC, et al. Celiac disease in type 1 diabetes mellitus in a North American community: prevalence, serologic screening, and clinical features. Mayo Clin Proc. 2005;80:1429–34.PubMedGoogle Scholar
  103. 103.
    Vicuna Arregui M, Zozaya Urmeneta JM, Martinez de Esteban JP, et al. [Study of celiac disease in adults with type 1 diabetes mellitus]. Gastroenterol Hepatol. 2010;33:6–11.PubMedGoogle Scholar
  104. 104.
    Cronin CC, Feighery A, Ferriss JB, et al. High prevalence of celiac disease among patients with insulin-dependent (type I) diabetes mellitus. Am J Gastroenterol. 1997;92:2210–2.PubMedGoogle Scholar
  105. 105.
    Sjoberg K, Eriksson KF, Bredberg A, et al. Screening for coeliac disease in adult insulin-dependent diabetes mellitus. J Intern Med. 1998;243:133–40.PubMedGoogle Scholar
  106. 106.
    Ch’ng CL, Jones MK, Kingham JG. Celiac disease and autoimmune thyroid disease. Clin Med Res. 2007;5:184–92.PubMedGoogle Scholar
  107. 107.
    Floreani A, Betterle C, Baragiotta A, et al. Prevalence of coeliac disease in primary biliary cirrhosis and of antimitochondrial antibodies in adult coeliac disease patients in Italy. Dig Liver Dis. 2002;34:258–61.PubMedGoogle Scholar
  108. 108.
    Kingham JG, Parker DR. The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences. Gut. 1998;42:120–2.PubMedGoogle Scholar
  109. 109.
    Volta U, Rodrigo L, Granito A, et al. Celiac disease in autoimmune cholestatic liver disorders. Am J Gastroenterol. 2002;97:2609–13.PubMedGoogle Scholar
  110. 110.
    Villalta D, Girolami D, Bidoli E, et al. High prevalence of celiac disease in autoimmune hepatitis detected by anti-tissue tranglutaminase autoantibodies. J Clin Lab Anal. 2005;19:6–10.PubMedGoogle Scholar
  111. 111.
    Tursi A, Giorgetti GM, Brandimarte G, Elisei W. High prevalence of celiac disease among patients affected by Crohn’s disease. Inflamm Bowel Dis. 2005;11:662–6.PubMedGoogle Scholar
  112. 112.
    Yang A, Chen Y, Scherl E, et al. Inflammatory bowel disease in patients with celiac disease. Inflamm Bowel Dis. 2005;11:528–32.PubMedGoogle Scholar
  113. 113.
    Naiyer AJ, Shah J, Hernandez L, et al. Tissue transglutaminase antibodies in individuals with celiac disease bind to thyroid ­follicles and extracellular matrix and may contribute to thyroid dysfunction. Thyroid. 2008;18:1171–8.PubMedGoogle Scholar
  114. 114.
    Ventura A, Magazzu G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Gastroenterology. 1999;117:297–303.PubMedGoogle Scholar
  115. 115.
    Franzese A, Iafusco D, Spadaro R, et al. Potential celiac disease in type 1 diabetes: a multicenter study. Diabetes Res Clin Pract. 2011;92:53–6.PubMedGoogle Scholar
  116. 116.
    Reunala T. Dermatitis herpetiformis: coeliac disease of the skin. Ann Med. 1998;30:416–8.PubMedGoogle Scholar
  117. 117.
    Collin P, Reunala T. Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists. Am J Clin Dermatol. 2003;4:13–20.PubMedGoogle Scholar
  118. 118.
    Gawkrodger DJ, Blackwell JN, Gilmour HM, et al. Dermatitis herpetiformis: diagnosis, diet and demography. Gut. 1984;25:151–7.PubMedGoogle Scholar
  119. 119.
    Lewis NR, Logan RF, Hubbard RB, West J. No increase in risk of fracture, malignancy or mortality in dermatitis herpetiformis: a cohort study. Aliment Pharmacol Ther. 2008;27:1140–7.PubMedGoogle Scholar
  120. 120.
    Reunala T, Collin P. Diseases associated with dermatitis herpetiformis. Br J Dermatol. 1997;136:315–8.PubMedGoogle Scholar
  121. 121.
    Rashtak S, Murray JA. Celiac disease in the elderly. Gastroenterol Clin North Am. 2009;38:433–46.PubMedGoogle Scholar
  122. 122.
    Nicolas ME, Krause PK, Gibson LE, Murray JA. Dermatitis herpetiformis. Int J Dermatol. 2003;42:588–600.PubMedGoogle Scholar
  123. 123.
    Korkut E, Bektas M, Oztas E, et al. The prevalence of celiac disease in patients fulfilling Rome III criteria for irritable bowel syndrome. Eur J Intern Med. 2010;21:389–92.PubMedGoogle Scholar
  124. 124.
    Ford AC, Chey WD, Talley NJ, et al. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch Intern Med. 2009;169:651–8.PubMedGoogle Scholar
  125. 125.
    Brandt LJ, Bjorkman D, Fennerty MB, et al. Systematic review on the management of irritable bowel syndrome in North America. Am J Gastroenterol. 2002;97:S7–26.PubMedGoogle Scholar
  126. 126.
    Gonda TA, Khan SU, Cheng J, et al. Association of intussusception and celiac disease in adults. Dig Dis Sci. 2010;55:2899–903.PubMedGoogle Scholar
  127. 127.
    Green PH, Alaedini A, Sander HW, et al. Mechanisms underlying celiac disease and its neurologic manifestations. Cell Mol Life Sci. 2005;62:791–9.PubMedGoogle Scholar
  128. 128.
    Hernandez L, Green PH. Extraintestinal manifestations of celiac disease. Curr Gastroenterol Rep. 2006;8:383–9.PubMedGoogle Scholar
  129. 129.
    Rashtak S, Snyder MR, Pittock SJ, et al. Serology of celiac disease in gluten-sensitive ataxia or neuropathy: role of deamidated gliadin antibody. J Neuroimmunol. 2011;230:130–4.PubMedGoogle Scholar
  130. 130.
    Revised criteria for diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition. Arch Dis Child. 1990;65:909–11.Google Scholar
  131. 131.
    Zintzaras E, Germenis AE. Performance of antibodies against tissue transglutaminase for the diagnosis of celiac disease: meta-analysis. Clin Vaccine Immunol. 2006;13:187–92.PubMedGoogle Scholar
  132. 132.
    Dieterich W, Esslinger B, Trapp D, et al. Cross linking to tissue transglutaminase and collagen favours gliadin toxicity in coeliac disease. Gut. 2006;55:478–84.PubMedGoogle Scholar
  133. 133.
    Marietta EV, Rashtak S, Murray JA. Correlation analysis of celiac sprue tissue transglutaminase and deamidated gliadin IgG/IgA. World J Gastroenterol. 2009;15:845–8.PubMedGoogle Scholar
  134. 134.
    Vermeersch P, Geboes K, Marien G, et al. Diagnostic performance of IgG anti-deamidated gliadin peptide antibody assays is comparable to IgA anti-tTG in celiac disease. Clin Chim Acta. 2010;411:931–5.PubMedGoogle Scholar
  135. 135.
    Volta U, Granito A, Parisi C, et al. Deamidated gliadin peptide antibodies as a routine test for celiac disease: a prospective analysis. J Clin Gastroenterol. 2010;44:186–90.PubMedGoogle Scholar
  136. 136.
    Kaukinen K, Collin P, Laurila K, et al. Resurrection of gliadin antibodies in coeliac disease. Deamidated gliadin peptide antibody test provides additional diagnostic benefit. Scand J Gastroenterol. 2007;42:1428–33.PubMedGoogle Scholar
  137. 137.
    Lewis NR, Scott BB. Meta-analysis: deamidated gliadin peptide antibody and tissue transglutaminase antibody compared as screening tests for coeliac disease. Aliment Pharmacol Ther. 2010;31:73–81.PubMedGoogle Scholar
  138. 138.
    Kumar V, Jarzabek-Chorzelska M, Sulej J, et al. Celiac disease and immunoglobulin a deficiency: how effective are the serological methods of diagnosis? Clin Diagn Lab Immunol. 2002;9:1295–300.PubMedGoogle Scholar
  139. 139.
    Green PH, Shane E, Rotterdam H, et al. Significance of unsuspected celiac disease detected at endoscopy. Gastrointest Endosc. 2000;51:60–5.PubMedGoogle Scholar
  140. 140.
    Walker MM, Murray JA. An update in the diagnosis of coeliac disease. Histopathology. 2011;59(2):166–79.PubMedGoogle Scholar
  141. 141.
    Murray JA, Rubio-Tapia A, Van Dyke CT, et al. Mucosal atrophy in celiac disease: extent of involvement, correlation with clinical presentation, and response to treatment. Clin Gastroenterol Hepatol. 2008;6:186–93; quiz 25.Google Scholar
  142. 142.
    Muhammad A, Pitchumoni CS. Newly detected celiac disease by wireless capsule endoscopy in older adults with iron deficiency anemia. J Clin Gastroenterol. 2008;42:980–3.PubMedGoogle Scholar
  143. 143.
    Culliford A, Daly J, Diamond B, et al. The value of wireless capsule endoscopy in patients with complicated celiac disease. Gastrointest Endosc. 2005;62:55–61.PubMedGoogle Scholar
  144. 144.
    Ciaccio EJ, Tennyson CA, Bhagat G, et al. Classification of videocapsule endoscopy image patterns: comparative analysis between patients with celiac disease and normal individuals. Biomed Eng Online. 2010;9:44.PubMedGoogle Scholar
  145. 145.
    Gonzalez S, Gupta A, Cheng J, et al. Prospective study of the role of duodenal bulb biopsies in the diagnosis of celiac disease. Gastrointest Endosc. 2010;72:758–65.PubMedGoogle Scholar
  146. 146.
    Walker MM, Murray JA, Ronkainen J, et al. Detection of celiac disease and lymphocytic enteropathy by parallel serology and histopathology in a population-based study. Gastroenterology. 2010;139:112–9.PubMedGoogle Scholar
  147. 147.
    Rostami K, Kerckhaert J, Tiemessen R, et al. Sensitivity of antiendomysium and antigliadin antibodies in untreated celiac disease: disappointing in clinical practice. Am J Gastroenterol. 1999;94:888–94.PubMedGoogle Scholar
  148. 148.
    Lee SK, Lo W, Memeo L, Rotterdam H, Green PH. Duodenal histology in patients with celiac disease after treatment with a gluten-free diet. Gastrointest Endosc. 2003;57:187–91.PubMedGoogle Scholar
  149. 149.
    Rubio-Tapia A, Rahim MW, See JA, et al. Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet. Am J Gastroenterol. 2010;105:1412–20.PubMedGoogle Scholar
  150. 150.
    Long KH, Rubio-Tapia A, Wagie AE, et al. The economics of coeliac disease: a population-based study. Aliment Pharmacol Ther. 2010;32:261–9.PubMedGoogle Scholar
  151. 151.
    Catassi C, Fabiani E, Iacono G, et al. A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. Am J Clin Nutr. 2007;85:160–6.PubMedGoogle Scholar
  152. 152.
    Collin P, Thorell L, Kaukinen K, Maki M. The safe threshold for gluten contamination in gluten-free products. Can trace amounts be accepted in the treatment of coeliac disease? Aliment Pharmacol Ther. 2004;19:1277–83.PubMedGoogle Scholar
  153. 153.
    Storsrud S, Hulthen LR, Lenner RA. Beneficial effects of oats in the gluten-free diet of adults with special reference to nutrient ­status, symptoms and subjective experiences. Br J Nutr. 2003;90:101–7.PubMedGoogle Scholar
  154. 154.
    Picarelli A, Di Tola M, Sabbatella L, et al. Immunologic evidence of no harmful effect of oats in celiac disease. Am J Clin Nutr. 2001;74:137–40.PubMedGoogle Scholar
  155. 155.
    Janatuinen EK, Kemppainen TA, Julkunen RJ, et al. No harm from five year ingestion of oats in coeliac disease. Gut. 2002;50:332–5.PubMedGoogle Scholar
  156. 156.
    AGA Institute. AGA Institute medical position statement on the diagnosis and management of celiac disease. Gastroenterology. 2006;131:1977–80.Google Scholar
  157. 157.
    Selimoglu MA, Karabiber H. Celiac disease: prevention and treatment. J Clin Gastroenterol. 2010;44:4–8.PubMedGoogle Scholar
  158. 158.
    Lerner A. New therapeutic strategies for celiac disease. Autoimmun Rev. 2010;9:144–7.PubMedGoogle Scholar
  159. 159.
    Tennyson CA, Lewis SK, Green PH. New and developing ­therapies for celiac disease. Ther Adv Gastroenterol. 2009;2:303–9.Google Scholar
  160. 160.
    Rubio-Tapia A, Murray JA. Classification and management of refractory coeliac disease. Gut. 2010;59:547–57.PubMedGoogle Scholar
  161. 161.
    Cellier C, Delabesse E, Helmer C, et al. Refractory sprue, coeliac disease, and enteropathy-associated T-cell lymphoma. French Coeliac Disease Study Group. Lancet. 2000;356:203–8.PubMedGoogle Scholar
  162. 162.
    Culliford AN, Green PH. Refractory sprue. Curr Gastroenterol Rep. 2003;5:373–8.PubMedGoogle Scholar
  163. 163.
    Rubio-Tapia A, Kelly DG, Lahr BD, et al. Clinical staging and survival in refractory celiac disease: a single center experience. Gastroenterology. 2009;136:99–107; quiz 352–3.Google Scholar
  164. 164.
    Malamut G, Afchain P, Verkarre V, et al. Presentation and long-term follow-up of refractory celiac disease: comparison of type I with type II. Gastroenterology. 2009;136:81–90.PubMedGoogle Scholar
  165. 165.
    Daum S, Ipczynski R, Heine B, et al. Therapy with budesonide in patients with refractory sprue. Digestion. 2006;73:60–8.PubMedGoogle Scholar
  166. 166.
    Brar P, Lee S, Lewis S, et al. Budesonide in the treatment of refractory celiac disease. Am J Gastroenterol. 2007;102:2265–9.PubMedGoogle Scholar
  167. 167.
    Jamma S, Leffler DA, Dennis M, et al. Small intestinal release mesalamine for the treatment of refractory celiac disease type I. J Clin Gastroenterol. 2011;45:30–3.PubMedGoogle Scholar
  168. 168.
    Askling J, Linet M, Gridley G, et al. Cancer incidence in a population-based cohort of individuals hospitalized with celiac disease or dermatitis herpetiformis. Gastroenterology. 2002;123:1428–35.PubMedGoogle Scholar
  169. 169.
    Peters U, Askling J, Gridley G, et al. Causes of death in patients with celiac disease in a population-based Swedish cohort. Arch Intern Med. 2003;163:1566–72.PubMedGoogle Scholar
  170. 170.
    Corrao G, Corazza GR, Bagnardi V, et al. Mortality in patients with coeliac disease and their relatives: a cohort study. Lancet. 2001;358:356–61.PubMedGoogle Scholar
  171. 171.
    Green PHR, Stavropoulos SN, Panagi SG, et al. Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol. 2001;96:126–31.PubMedGoogle Scholar
  172. 172.
    Green PH, Fleischauer AT, Bhagat G, Goyal R, Jabri B, Neugut AI. Risk of malignancy in patients with celiac disease. Am J Med. 2003;115:191–5.PubMedGoogle Scholar
  173. 173.
    Catassi C, Bearzi I, Holmes GK. Association of celiac disease and intestinal lymphomas and other cancers. Gastroenterology. 2005;128:S79–86.PubMedGoogle Scholar
  174. 174.
    Di Sabatino A, Corazza GR. Coeliac disease. Lancet. 2009;373:1480–93.PubMedGoogle Scholar
  175. 175.
    Godfrey JD, Brantner TL, Brinjikji W, et al. Morbidity and mortality among older individuals with undiagnosed celiac disease. Gastroenterology. 2010;139:763–9.PubMedGoogle Scholar
  176. 176.
    Murray JA. The widening spectrum of celiac disease. Am J Clin Nutr. 1999;69:354–65.PubMedGoogle Scholar
  177. 177.
    Lewis NR, Holmes GK. Risk of morbidity in contemporary celiac disease. Expert Rev Gastroenterol Hepatol. 2010;4:767–80.PubMedGoogle Scholar
  178. 178.
    Grainge MJ, West J, Card TR, et al. Causes of death in people with celiac disease spanning the pre- and post- serology era: a polulation based cohort study from Derby, UK. Am J Gastroenterol. 2011;106:933–9.PubMedGoogle Scholar
  179. 179.
    Roshan B, Leffler DA, Jamima S, et al. The incidence and clinical spectrum of refractory celiac disease in a North American referral center. Am J Gastroenterol. 2011;106:923–8.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • C. S. Pitchumoni
    • 1
  • C. S. Pitchumoni
    • 2
  • C. S. Pitchumoni
    • 3
  • Nancy Chen
    • 4
  1. 1.Robert Wood Johnson School of Medicine, Drexel University School of MedicinePhiladelphiaUSA
  2. 2.New York Medical CollegeVallhalaUSA
  3. 3.Gastroenterology, Hepatology and NutritionSaint Peter’s University HospitalNew BrunswickUSA
  4. 4.Department of GastroenterologyRobert Wood Johnson University HospitalNew BrunswickUSA

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