Complications
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 relatively low (hazard ratio [HR] 1.11; 95% CI 1.07 to 1.15), and in a recent population study, cancers were diagnosed in the first year after diagnosis (HR 2.47; 95% CI 2.22 to 2.74) and not subsequently. The risk was highest in those diagnosed with coeliac disease after the age of 60 years (HR 1.22; 95% CI 1.16 to 1.29) and did not affect those diagnosed with coeliac disease before the age of 40 years.[174] No additional screening is currently recommended, but symptoms and/or anaemia despite the gluten-free diet should prompt a re-evaluation of the small bowel.[175][176]
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.[177]
A predisposition to poor immune response to the hepatitis B virus vaccine has been observed in both adults and children with active coeliac disease.[181][182] Confirming the response to immunisation is advisable and non-responders should be re-vaccinated once adherence to the gluten-free diet is optimal.[182][183]
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