GASTROINTESTINAL DISEASES
dermatitis herpetiformis, iron-deficiency anemia, idiopathic elevated transaminases, short stature, and osteopenia/osteoporosis, and may develop in patients of all ages, making diagnosis difficult.1-4 Patients who remain undiagnosed are at increased risk for long-term complications, including infertility, osteoporosis, gastrointestinal malignancy, and enteropathy-associated T-cell lymphoma.2,9 With early detection and adherence to a gluten-free diet, these risks may be diminished with resolution of symptoms.9 This places important emphasis on the primary care provider’s ability to recognize common extraintestinal presentations of atypical CD, which are often associated with nonspecific complaints. ■
12. Reunala T, Salmi TT, Hervonen K, Kaukinen K, Collin P. Dermatitis herpetiformis: a common extraintestinal manifestation of coeliac disease. Nutrients. 2018;10(5):602. 13. Kárpáti S. Dermatitis herpetiformis. Clin Dermatol. 2012;30(1):56-59. 14. Mahadev S, Laszkowska M, Sundström J, et al. Prevalence of celiac disease in patients with iron deficiency anemia-a systematic review with metaanalysis. Gastroenterology. 2018;155(2):374-382.e1. 15. Hernandez L, Green PH. Extraintestinal manifestations of celiac disease. Curr Gastroenterol Rep. 2006;8(5):383-389. 16. Rubio-Tapia A, Murray JA. The liver in celiac disease. Hepatology. 2007;46(5):1650-1658. 17. van Rijn JC, Grote FK, Oostdijk W, Wit JM. Short stature and the probability of coeliac disease, in the absence of gastrointestinal symptoms.
Rachel Ziganti, MPA, PA-C, is a physician assistant working with the Department of Rheumatic and Immunologic Diseases of the Cleveland Clinic in Cleveland, Ohio; Stevie Redmond, MPA, PA-C, is director of education and associate professor in the Physician Assistant Department at Augusta University in Augusta, Georgia.
Arch Dis Child. 2004;89(9):882-883. 18. Gadewar S, Fasano A. Celiac disease: is the atypical really typical? Summary of the recent National Institutes of Health Consensus Conference and latest advances. Curr Gastroenterol Rep. 2005;7(6):455-461. 19. Stenson WF, Newberry R, Lorenz R, Baldus C, Civitelli R. Increased prevalence of celiac disease and need for routine screening among patients
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