Complications

Complications table
Complication Timeframe Likelihood

osteoporosis/osteopenia

variable medium

Reduced bone mineral density is common in celiac disease and often improves significantly within 1 year of gluten withdrawal.

Although timing varies according to different guidelines, bone mineral density may be checked in patients after they have been on a gluten-free diet for 1 year. [43] [100] [101] [102] [103] [104]

dermatitis herpetiformis

variable medium

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.

malignancy

variable low

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 [97] ) and appears to normalize within a few years of gluten withdrawal. No additional screening is recommended. [98] [99]

idiopathic recurrent acute pancreatitis/chronic pancreatitis

variable low

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.

pneumococcal infection

variable low

Hyposplenism has been associated with celiac disease, thus increasing the risk of infections from encapsulated bacteria such as pneumococcus. [105] Some guidelines recommend vaccination against pneumococci, Haemophilus influenzae , and meningococci for celiac disease patients. [103] [104]

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