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Review

Celiac disease: Managing a multisystem disorder

Gursimran Singh Kochhar, MD, CNSC, FACP, Tavankit Singh, MD, Anant Gill, MBBS and Donald F. Kirby, MD, FACP, FACN, FACG, AGAF, CNSC, CPNS
Cleveland Clinic Journal of Medicine March 2016, 83 (3) 217-227; DOI: https://doi.org/10.3949/ccjm.83a.14158
Gursimran Singh Kochhar
Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic
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Tavankit Singh
Department of Internal Medicine, Cleveland Clinic
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Anant Gill
Saraswathi Institute of Medical Sciences, Anwarpur, Uttar Pradesh, India
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Donald F. Kirby
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  • For correspondence: [email protected]
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  • FIGURE 1
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    FIGURE 1

    Celiac disease is an autoimmune disorder that, in genetically susceptible individuals, is triggered by ingestion of foods containing gluten. IgA = immunoglobulin A; tTG = tissue transglutaminase.

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    FIGURE 2

    Eroded and crusted erythematous plaques with scalloped borders on the elbow of a patient with dermatitis herpetiformis.

    Photo courtesy of Alok Vij, Department of Dermatology, Cleveland Clinic.

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    FIGURE 3

    Vesicles in a patient with dermatitis herpetiformis.

    Photo courtesy of Alok Vij, MD, Department of Dermatology, Cleveland Clinic.

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    FIGURE 4
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    FIGURE 5

    Low-power view of a duodenal biopsy sample in a patient with celiac disease shows altered duodenal mucosal architecture with villous blunting and crypt hyperplasia (hematoxylin and eosin, original magnification × 20).

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    FIGURE 6

    There are increased intraepithelial lymphocytes, including at the tips of villi, as well as an expanded lamina propria lymphoplasmacellular infiltrate (hematoxylin and eosin, original magnification × 20).

    Photomicrograph courtesy of Homer Wiland MD, Department of Pathology, Cleveland Clinic.

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    TABLE 1

    Diseases associated with celiac disease

    Endocrine
    Hashimoto thyroiditis
    Type 1 diabetes mellitus
    Addison disease
    Osteoporosis
    Osteopenia
    Dermatologic
    Dermatitis herpetiformis
    Alopecia areata
    Hepatic
    Autoimmune hepatitis
    Primary biliary cirrhosis
    Primary sclerosing cholangitis
    Nonalcoholic fatty liver disease
    Obstetric and gynecologic
    Amenorrhea
    Delayed menarche
    Early menopause
    Recurrent spontaneous abortion
    Infertility
    Loss of libido
    Neurologic
    Cerebellar ataxia
    Peripheral neuropathy
    Epilepsy
    Dementia
    Psychiatric
    Depression
    Schizophrenia
    Oncologic
    Intestinal T-cell lymphoma
    Adenocarcinoma of small intestine
    Cardiac
    Autoimmune myocarditis
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    TABLE 2

    Foods that can be eaten on a gluten-free diet

    Foods allowed
    BeansVegetablesPotatoes
    SeedsDairy productsVegetable oil
    Nuts (unprocessed)CornOlive oil
    Fresh eggsMilletRice cakes
    Fresh meatRiceHomemade popcorn
    FishSorghumTea
    PoultrySoyCoffee
    FruitsOatsFresh juices
    Foods allowed if they are labeled as gluten-free
    BeerCerealsSalad dressings
    BreadCookiesMilk puddings
    CakesCrackersIce creams
    PiesFrench fries
    CandiesPasta
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Cleveland Clinic Journal of Medicine: 83 (3)
Cleveland Clinic Journal of Medicine
Vol. 83, Issue 3
1 Mar 2016
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Celiac disease: Managing a multisystem disorder
Gursimran Singh Kochhar, Tavankit Singh, Anant Gill, Donald F. Kirby
Cleveland Clinic Journal of Medicine Mar 2016, 83 (3) 217-227; DOI: 10.3949/ccjm.83a.14158

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Celiac disease: Managing a multisystem disorder
Gursimran Singh Kochhar, Tavankit Singh, Anant Gill, Donald F. Kirby
Cleveland Clinic Journal of Medicine Mar 2016, 83 (3) 217-227; DOI: 10.3949/ccjm.83a.14158
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  • Article
    • ABSTRACT
    • GENETIC PREDISPOSITION AND DIETARY TRIGGER
    • CLINICAL FEATURES
    • CELIAC DISEASE-ASSOCIATED MALIGNANCY
    • DIAGNOSIS: SEROLOGY, BIOPSY, GENETIC TESTING
    • A GLUTEN-FREE DIET IS THE MAINSTAY OF TREATMENT
    • NOVEL THERAPIES BEING TESTED
    • NONRESPONSIVE AND REFRACTORY CELIAC DISEASE
    • NONCELIAC GLUTEN SENSITIVITY DISORDER
    • REFERENCES
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