Complications
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 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 celiac disease after the age of 60 years (HR 1.22; 95% CI 1.16 to 1.29) and did not affect those diagnosed with celiac disease before the age of 40 years.[184] No additional screening is currently recommended, but symptoms and/or anemia despite the gluten-free diet should prompt a re-evaluation of the small bowel.[185][186]
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.[187]
A predisposition to poor immune response to the hepatitis B virus vaccine has been observed in both adults and children with active celiac disease.[190][191] Confirming the response to immunization is advisable and nonresponders should be revaccinated once adherence to the gluten-free diet is optimal.[191][192]
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