Reduced bone mineral density is common in celiac disease and often improves significantly within 1 year of gluten withdrawal.
Dermatitis herpetiformis is the skin manifestation of active celiac 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 celiac disease, including intestinal and extraintestinal lymphoma and carcinomas of the upper digestive tract.
The magnitude of increased risk is moderate (standardized incidence ratio of 1.3, 95% confidence interval 1.2 to 1.5 in one study) and appears to normalize within a few years of gluten withdrawal. No additional screening is recommended.
idiopathic recurrent acute pancreatitis/chronic pancreatitis
Celiac 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 celiac disease and persistent diarrhea, pancreatic exocrine insufficiency can be considered.
Hyposplenism has been associated with celiac disease, thus increasing the risk of infections from encapsulated bacteria such as pneumococcus. Some guidelines recommend vaccination against pneumococci, Haemophilus influenzae, and meningococci for celiac disease patients.
nonresponse 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 celiac disease. Confirming the response to immunization is advisable and nonresponders should be revaccinated once adherence to the gluten-free diet is optimal.
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