Celiac Disease: Complications

The following are the most important diseases or complications that may be contributed to by celiac disease (gluten-induced enteropathy):

Eyes and eye appendages (H00-H59).

Blood, blood-forming organs – immune system (D50-D90).

Certain conditions originating in the perinatal period (P00-P96).

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Autoimmunity:
    • Autoimmune thyroiditis
    • Diabetes mellitus type 1
  • Overweight (28%), obesity grade I (10%).

Skin and subcutaneous tissue (L00-L99)

  • Dermatitis herpetiformis Duhring (dhD) – chronic skin disease with herpes-like efflorescences (pathological skin lesions: 0.1-0.2 cm large, urticarial papules (nettle-like nodules), vesicles and/or erosions (superficial substance defects confined to the epidermis, without scarring)) and usually severe itching; closely related to celiac disease (gluten-sensitive enteropathy): almost every disease is based on a, usually asymptomatic, celiac disease as primary disease (only approx. 25% of all dermatitis herpetiforme patients manifest gastroenterological symptoms); a lifelong gluten-free diet cures this disease.

Cardiovascular system (I00-I99).

Liver, gallbladder, and bile ducts-pancreas (pancreas) (K70-K77; K80-K87).

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

  • Dysbiosis (imbalance of intestinal flora).
  • Lactase deficiency due to a reduction in enzyme activity in the small intestine (secondary lactase deficiency).
  • Refractory celiac disease (approximately 1.5% of cases):
    • Enteropathy-associated T-cell lymphoma (ETZL; see below).
    • Ulcerative jejunitis – inflammation of the jejunum (empty bowel, a part of the small intestine).
  • Steatorrhea (fatty stools)
  • Ulceration (ulceration) in the gastrointestinal tract.
  • Insufficient intake of nutrients and vital substances (macro- and micronutrients), especially vitamins A, D, E and K and essential fatty acids.

Musculoskeletal system and connective tissue (M00-M99).

  • Arthritis (inflammation of the joints)
  • Muscle cramps
  • Muscle atrophy
  • Osteomalacia (bone softening) due to vitamin D deficiency.
  • Osteoporosis (bone loss) due tovitamin D deficiency; especially older patients.
  • Rickets (English disease) – disease of the skeletal system, usually caused by vitamin D deficiency; the most important symptom is bone deformities due tovitamin D deficiency.

Neoplasms – tumor diseases (C00-D48).

  • Lymphomas, mainly in the small intestine, in refractory celiac disease type II: enteropathy associated T-cell lymphomas (ETZL; T-NHL), belong to the group of non-Hodgkin’s lymphomas (risk of lymphoma in celiac disease increased 8- to 30-fold: over 5 years of follow-up about 30-40%).
  • Non-closely labeled neoplasms (neoplasms) outside the gastrointestinal tract (gastrointestinal tract) – e.g. basal cell carcinoma (BZK; basal cell carcinoma)/malignant (malignant) skin tumor that does not metastasize daughter tumors) forms.
  • Tumors of the gastrointestinal tract such as carcinoma of the small intestine, colon and esophagus (cancer of the small intestine, colon and esophagus).

Psyche – Nervous System (F00-F99; G00-G99).

  • Anxieties
  • Depression
  • Cephalgia (headache)
  • Epilepsy (seizure disorder) – risk for patients with celiac disease to develop epilepsy in the future was significantly increased (in children HR 1.42 and in adolescents (age < 20 years) at 1.58)
  • Muscle weakness
  • Peripheral neuropathy (diseases of the peripheral nervous system).
  • Behavioral and personality abnormalities (psychosocial retardation).
  • Cerebral ataxia (disorders of movement coordination (ataxia) caused by pathological changes in the cerebellum).

Pregnancy, childbirth, and puerperium (O00-O99).

  • Abortion (miscarriage)
  • Premature birth

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Edema – water retention in tissues.
  • Weight loss, up to cachexia (emaciation; very severe emaciation).
  • Tetany – syndrome of neuromuscular hyperexcitability. It leads mainly to painful muscle cramps.
  • Growth disorders

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99)

Injuries, poisonings, and other consequences of external causes (S00-T98).

  • Hematomas (bruises)

Ultimately, depending on the degree of villous atrophy, the impairments of the intestinal wall lead to a disturbance of the absorption function and thus to an insufficient absorption of nutrients and vital substances (macro- and micronutrients). In the course of celiac disease, fat and lactose absorption are particularly impaired. If the intake of foods rich in fats and lactose is therefore largely restricted, the typical symptoms, such as diarrhea and meteorism (bloated abdomen), are reduced. There, they accelerate the intestinal passage by stimulating peristalsis and finally trigger steatorrhea (chologenic fatty stool) as a result of the increase in fecal fat excretion. The increased loss of fat via the stool also results in increased loss of fat-soluble vitamins A, D, E, and K, as well as essential fatty acids. Depending on the extent of the fat absorption disorder, this results in reduced utilization of vital substances, negative energy balance and thus weight loss. Often, affected individuals suffer from clinical deficiency symptoms due to vitamin, mineral, and protein deficiencies in addition to digestive disorders due to malabsorption. In particular, the fatty diarrhea (steatorrhea) that often occurs in celiac disease patients is associated with high losses of essential fatty acids and the fat-soluble vitamins A, D, E and K. The diarrhea is often watery, and the body is often deprived of vitamins, minerals and proteins. The often watery diarrhea causes increased amounts of fluid, water-soluble vitamins of the B group, and electrolytes such as sodium, potassium, calcium, magnesium, and chloride to be excreted [1,2].In a large proportion of gluten-sensitive people, the immune system already sees grain protein as a foreign body in infancy. Early sensitization to gluten then represents the trigger of gluten-sensitive enteropathy.For this reason, gluten-containing foods should not be offered to infants until they are four months old.Because genetic conditions favor the development of celiac disease, individuals in whose families this condition is frequently found are particularly at risk.

Celiac disease (gluten-induced enteropathy) – enteral protein loss syndrome

Impairment of the intestinal mucosa results in increased intestinal protein loss, as leakage of plasma proteins through the intestinal mucosa into the gut exceeds the rate of protein synthesis. The decrease in circulating plasma proteins is usually accompanied by a severe protein deficiency. In addition, increased intestinal protein loss leads to a decrease in oncotic pressure and thus, depending on the extent of the decreased concentration of plasma proteins (hypoproteinemia), to the formation of edema.