Celiac Disease and Concomitant Conditions: A Case-based Review

Abstract

Celiac disease is a chronic autoimmune disease with genetic predisposition, triggered by the ingestion of gluten. It has a wide range of clinical manifestations ranging from asymptomatic forms to classic presentation of malabsorption with diarrhea and abdominal cramps. Celiac disease can also present with several other concomitant disorders (at the time of diagnosis or during the course of celiac disease) such as: type 1 diabetes, inflammatory bowel disease, rheumatoid arthritis, thyroid disorders, nutritional deficiencies, and gram-negative sepsis. We present a 57-year-old female with past medical history of rheumatoid arthritis, who presented to the emergency department with a complaint of chronic diarrhea, complicated by gram-negative sepsis. The family history of the patient was significant for celiac disease, type 1 diabetes, and rheumatoid arthritis. The patient was closely monitored and treated appropriately. In this case-based review, we explore different associated conditions of celiac disease in the literature, as well as the patient's risk of developing malignancy.

Serum creatinine/cystatin C ratio as a surrogate marker for sarcopenia in patients with chronic obstructive pulmonary disease

“…Patients on methotrexate had a significantly reduced intake of folic acid as a percentage of RDI compared with those on other therapies Cehran et al, 2003 [67] Cohort study Moderate Intake of certain antioxidant micronutrients, particularly beta-cryptoxanthin and supplemental zinc, and possibly diets high in fruits and cruciferous vegetables, may be protective against the development of RA Tanner et al, 1990 [68] Observational study Moderate A subset of RA patients might have food sensitivity as a component of clinical activity Carbohydrates Strenght of evidence: MODERATE Zhernakova et al, 2011 [69] Meta-analysis High Some gene loci established in either celiac disease (CD) or RA are associated with the other autoimmune disease Voight et al, 2012 [70] Narrative review Low Autoimmune and inflammatory diseases share an underlying genetic basis in common Lerner et al, 2015 [71] Narrative review Low The intestinal mucosa have all the necessary tools to produce neo-epitopes, breaking tolerance to self-antigens, by citrullination (PAD) and crosslinking (tTg, neo-epitope tTg, mTg) initiating autoimmunogenic dysregulation and autoantibody generation in RA Collin et al, 1994 [72] Case-control study Moderate RA can present with several other concomitant disorders such as CD Lodhi et al, 2018 [73] Case report Low RA can present with several other concomitant disorders such as CD Warjri et al, 2015 [74] Case report Low Gut-derived antigens of CD may have a role in the pathogenesis of other autoimmune disorders including RA He et al, 2016 [62] Cross sectional study Moderate High intakes of carbohydrates (e.g., potatoes) might be associated with increased RA risks Hu et al, 2017 [55] Cohort study Moderate A healthier diet, with fruits and whole grains, is associated with a reduced risk of RA occurring at 55 years of age or younger, particularly seropositive RA Hu et al, 2014 [75] Cohort study Moderate Regular consumption of sugar-sweetened soda, but not diet soda, is associated with increased risk of seropositive RA in women De Christopher et al, 2016 [76] Cross sectional study Moderate Beverages with excess free fructose intake are significantly associated with arthritis in US adults aged 20e30 years Barber et al, 2015 [77] Systematic Review High Regular screening for CV disease risk factors is an important part of care in patients with RA Lindhardsen et al, 2011 [78] Cohort study Moderate RA is associated with the same risk of myocardial infarction as diabetes mellitus Extra-virgin olive oil Strenght of evidence: MODERATE Linos et al, 1999 [54] Case-control study Moderate Consumption of both cooked vegetables and olive oil is inversely and independently associated with risk of RA Hu et al, 2017 [55] Cohort study Moderate A healthier diet, with extra virgin olive oil, is associated with a reduced risk of RA occurring at 55 years of age or younger, particularly seropositive RA Rosell et al, 2009 …”

The difference in symmetry of the enamel defects in celiac disease versus non-celiac pediatric population

“…Celiac disease (CD) is an immune-mediated enteropathy that affects genetically susceptible people following exposure to dietary gluten. 1 , 2 , 3 , 4 , 5 , 6 , 7 CD individuals may have gastrointestinal symptoms with a typical enteropathy, characterized by a malabsorption syndrome, extraintestinal symptoms or none of these. 6 , 8 , 9 …”

Craniofacial Morphometric Measurements of Children with Celiac Disease

“…Development of craniofacial structures and morphometric measurements and ratios is a complex process affected by many factors (6)(7)(8)(10)(11)(12)(13)(14)(15). Due to malabsorption most prominently in proximal small intestine, celiac disease is characterized by vitamin and mineral deficiencies including calcium, copper, foliate, and zinc deficiencies (11). The data on the effects of these vitamin deficiencies in 2…”

“…Since craniofacial anthropometry and morphometric measurements are affected by genetic, embryogenic and environmental factors, these measurements are used in determination of variations and medical problems associated with the development (7,(10)(11)(12)(13)(14)(15)(16)(17). Although growth retardation is a well-known, common finding in children with celiac disease, the extent to which craniofacial development is affected is not known clearly (16).…”