Reduced bone mineral density is common in coeliac disease and often improves significantly within 1 year of gluten withdrawal.
Dermatitis herpetiformis is the skin manifestation of active coeliac disease. Episodes can recur even on a strict gluten-free diet. In these patients, treatment with dapsone in conjunction with the gluten-free diet may be helpful.
Some malignancies are more common in patients with coeliac disease, including intestinal and extra-intestinal lymphoma and carcinomas of the upper digestive tract.
The magnitude of increased risk is moderate (standardised incidence ratio of 1.3, 95% confidence interval 1.2 to 1.5 in one study) and appears to normalise within a few years of gluten withdrawal. No additional screening is recommended.
idiopathic recurrent acute pancreatitis/chronic pancreatitis
Coeliac disease may present as recurrent acute pancreatitis or be complicated by chronic pancreatitis. Both conditions are unusual and do not warrant screening. In patients with treated coeliac disease and persistent diarrhoea, pancreatic exocrine insufficiency can be considered.
Hyposplenism has been associated with coeliac disease, thus increasing the risk of infections from encapsulated bacteria such as pneumococcus. Some guidelines recommend vaccination against pneumococci, Haemophilus influenzae, and meningococci for coeliac disease patients.
non-response to hepatitis B virus vaccine
A predisposition to poor immune response to the hepatitis B virus vaccine has been observed in both adults and children with active coeliac disease. Confirming the response to immunisation is advisable and non-responders should be re-vaccinated once adherence to the gluten-free diet is optimal.
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