Body systemPresentation
General systemicAdults: lassitude, inanition, depression, fatigue, irritability, general malnutrition with or without weight loss
Children: irritability, fretfulness, emotional withdrawal or excessive dependence, nausea, anorexia, malnutrition with protruberant abdomen, muscle wasting of buttocks, thighs and proximal arms; with or without vomiting and diarrhea
Skin and mucous membranesAphthous stomatitis (recurrent)
Angular cheilitis
Atopic dermatitis (persistent or recurrent)
Dermatitis herpetiformis (in 5 percent of patients with celiac disease)
Alopecia areata (especially alopecia universalis)
Melanosis (chloasma bronzium)
Erythema nodosum
Skeletal systemOsteoporosis/osteopenia (in 100 percent of patients with celiac disease)
Dental enamel defects
Short stature
Arthritis or arthralgia (central arthritis-sacroiliitis in 63 percent of patients with celiac disease)
Bone pain, especially nocturnal
Hematologic systemAnemia (iron deficiency is the most common cause), folic acid deficiency in 10 to 40 percent of children and 90 percent of adults; B12 deficiency (rare)
Leukopenia, coagulopathy and thrombocytosis.
Gastrointestinal systemDiarrhea in 60 percent of patients (small intestinal type), early diarrhea occurs with infrequent, large, watery, foul stools; later diarrhea occurs more frequently
Constipation in 20 percent of patients, with occasional obstipation and pseudo-obstruction
Lactose intolerance in 50 percent of patients with gastrointestinal symptoms
Anorexia, nausea, vomiting, abdominal pain and bloating
Pancreatitis, hepatitis, lymphoma
Immune systemAssociated autoimmune diseases:
Diabetes mellitus type 1
Thyroid disease
Sjögren's syndrome
Collagen disorders
Rheumatoid arthritis
Liver disease
Selective IgA deficiency
Reproductive systemDelayed puberty
Infertility
Neurologic systemSeizures, with or without occipital calcification
Unexplained neuropathic illnesses, including ataxia and peripheral neuropathies
Dementia
Other associated conditionsDown syndrome
IgA nephropathy
Fibrosing alveolitis of the lung
Hyposplenism, with atrophy of the spleen