Clinical signs start in early infancy a few weeks
after a diet containing gluten is added to breast-feeding. Intestinal
symptoms are variable, including diarrhea, nausea, vomiting, bloating,
steatorrhea, and constipation. Other features include failure to thrive,
anorexia, hypoprothrombinemia as a result of malabsorption of vitamin K,
osteoporosis, defective enamel, skin rash (dermatitis herpetiformis Duhring;
a papulovesicular skin condition), recurrent aphthous stomatitis, edema as a
result of hypoproteinemia, decreased blood levels of vitamin A and E, anemia
as a result of folate deficiency and/or iron deficiency, and rickets
secondary to vitamin D malabsorption. Puberty may be delayed, and refractory
epilepsy associated with brain calcifications has been reported in 5%
of patients. Arthritis occurs frequently in adults (26%) and requires
regular followup. Serum prolactin in patients with active celiac disease is
significantly higher and can be correlated to the degree of mucosal atrophy.
Celiac disease is more common in patients also suffering from other genetic
or immune diseases (e.g., Down syndrome, selective IgA deficiency, IgA
nephropathy, rheumatoid arthritis, thyroid diseases, insulin-dependent
diabetes mellitus). Children with diabetes mellitus, even when asymptomatic,
should be screened yearly for celiac disease. A significantly increased
risk for intestinal adenocarcinomas, non-Hodgkin (T-cell) lymphomas, and
squamous cell carcinomas of the oropharynx and esophagus has been reported
in patients with long-standing celiac disease.