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Celiac.com 09/12/2024 - Celiac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. This condition affects roughly one in 133 people worldwide, though it often goes undiagnosed due to its diverse symptoms. Celiac disease can co-occur with other autoimmune diseases, complicating its presentation and management. The disease’s prevalence and diagnosis are influenced by demographic and genetic factors, making it a significant health concern globally. Ophthalmic Manifestations of Celiac Disease Celiac disease is not just a gastrointestinal disorder; it can also have various ophthalmic manifestations. Patients with celiac disease may exhibit a range of eye-related issues that are not typically associated with the condition, such as decreased endothelial cell density, vitamin A deficiency causing dryness, altered corneal nerve density, cataracts, uveitis, changes in choroidal thickness, papilledema, and neurological issues like nystagmus. These manifestations highlight the systemic nature of celiac disease and the importance of comprehensive care. The Need for Thorough Evaluation Before Corneal Refractive Surgery Corneal refractive surgery, which includes procedures like LASIK, is increasingly popular for correcting vision problems. However, for patients with celiac disease, it is crucial to conduct a thorough evaluation before proceeding with such surgeries. The variability in ocular manifestations among celiac patients necessitates individualized assessments to determine surgical candidacy and optimize outcomes. This evaluation should include both subjective and objective assessments. Subjective Assessments A detailed medical history focusing on the patient’s experience with celiac disease is essential. This includes questions about dietary gluten intake, weight loss, joint pain, and cognitive impairments like brain fog. Understanding these aspects can help in identifying potential complications that might affect surgical outcomes. Objective Assessments A comprehensive objective assessment should include several diagnostic tests: Slit-lamp biomicroscopy to examine the eye’s structures. Schirmer test and tear break-up time (TBUT) to assess tear production and dry eye. Optical coherence tomography (OCT) to measure retinal and choroidal thickness. Scheimpflug imaging and fundoscopy to evaluate the anterior and posterior segments of the eye. Specific Considerations for Celiac Disease Patients Given the diverse ocular manifestations associated with celiac disease, several specific considerations should be addressed: Dry Eye Disease: Patients with celiac disease are more prone to dry eye disease. Symptoms like ocular discomfort, irritation, redness, and burning can be managed with artificial tears and punctal plugs before surgery. Endothelial Cell Density (ECD): Celiac disease patients may have lower ECD, which can lead to corneal edema post-surgery. Specular microscopy is recommended to evaluate ECD before proceeding with surgery. Anterior Chamber Depth (ACD): Some celiac disease patients might have shallower ACDs, which can indicate early-onset cataracts. Scheimpflug imaging can help assess ACD. Choroidal and Retinal Health: OCT is crucial to evaluate choroidal thickness and retinal health. Thinner choroids and other posterior segment abnormalities can affect visual outcomes post-surgery. Thyroid-Associated Orbitopathy (TAO): Celiac disease patients may also suffer from TAO, which can impact corneal health and refractive surgery outcomes. Thyroid function tests and orbital ultrasound are necessary for a thorough evaluation. Vitamin A Deficiency: This can lead to dryness and other ocular surface issues. Serum retinol levels should be checked, and vitamin A supplementation should be managed appropriately. Neurological Issues: Conditions like gluten ataxia and nystagmus can complicate surgery due to motor control issues. These conditions need careful assessment and management. Autoimmune Co-morbidities: The presence of other autoimmune conditions, like Type 1 Diabetes Mellitus, can increase the risk of complications like diabetic retinopathy, impacting surgical outcomes. Comprehensive retinal evaluations are necessary in these cases. Conclusion: The Importance of Comprehensive Care This study underscores the need for a thorough and individualized evaluation of celiac disease patients considering corneal refractive surgery. By addressing the various ophthalmic manifestations and related autoimmune conditions, healthcare providers can improve surgical outcomes and patient satisfaction. The recommendations provided in this study serve as preliminary guidelines, highlighting the importance of further research to better understand the impact of celiac disease on corneal refractive surgery outcomes. For celiac patients, these insights are crucial, as they emphasize the need for comprehensive care and tailored management strategies to ensure the best possible surgical results. Read more at: cureus.com

Celiac.com 02/27/2019 - Celiac disease is an autoimmune condition with numerous symptoms, and associated conditions. People with celiac disease often have gastrointestinal symptoms, including upset stomach, abdominal pain, gas, bloating, indigestion, and diarrhea. Some suffer from many of these on a regular basis. However, many people show few or no symptoms. No single set of signs or symptoms is typical for everyone with celiac disease. Signs and symptoms can vary greatly from person to person. Symptoms of Celiac Disease Fall Into 7 Major Categories Digestive symptoms such as abdominal pain, bloating, gas, diarrhea, constipation, nausea, vomiting, and steatorrhea (fatty stools); Non-digestive symptoms such as fatigue, weakness, anemia, weight loss, malnutrition, delayed growth, irritability, depression, anxiety, and cognitive impairment; Dermatological symptoms such as skin rash, itching, blistering, and dermatitis herpetiformis; Musculoskeletal symptoms such as joint pain, muscle pain, muscle cramps, and osteoporosis; Neurological symptoms such as headache, migraine, ataxia, neuropathy, seizures, and cognitive impairment; Reproductive symptoms such as infertility, menstrual irregularities, and recurrent miscarriage. No obvious symptoms or asymptomatic; Symptoms Can Vary Between Children and Adults The signs and symptoms of celiac disease can vary greatly and are different in children and adults. The most common signs for adults are diarrhea, fatigue and weight loss. Adults may also experience bloating and gas, abdominal pain, nausea, constipation, and vomiting. Many symptoms caused by celiac disease are the result of nutritional deficiencies caused by flattened villi and subsequent malabsorption. Symptoms in Children Children under 2 years old celiac symptoms often include vomiting, chronic diarrhea, failure to thrive, muscle wasting, poor appetite, and swollen belly. Older children may experience diarrhea, constipation, weight loss, irritability, short stature, delayed puberty, and neurological symptoms, including attention-deficit/hyperactivity disorder (ADHD), learning disabilities, headaches, lack of muscle coordination and seizures Vague Symptoms Can Delay Celiac Diagnosis It is not uncommon for symptoms of celiac disease to be vague or confusing. Vague or confusing symptoms can include dental enamel defects, bone disorders like osteoporosis, depression, irritability, joint pain, mouth sores, muscle cramps, skin rash, stomach discomfort, and even neuropathy, often experienced as tingling in the legs and feet. To make matters more challenging, celiac symptoms can also mimic symptoms of other diseases, such as anemia, Crohns disease, gastric ulcers, irritable bowel, parasitic infection, even various skin disorders or nervous conditions. Vague or confusing symptoms can delay celiac disease diagnosis. Signs and Symptoms of Celiac Disease Abdominal cramps, gas and bloating Acne Anemia Ataxia (gluten ataxia) Borborygmi—stomach rumbling Coetaneous bleeding Delayed puberty Dental enamel defects Diarrhea Dry skin Easy bruising Epistaxis—nose bleeds Eczema Failure to thrive or short stature Fatigue or general weakness Flatulence Fluid retention Folic acid deficiency Foul-smelling yellow or grayish stools that are often fatty or oily Gastrointestinal symptoms Gastrointestinal hemorrhage General malaise, feeling unwell Hematuria—red urine Hypocalcaemia/hypomagnesaemia Infertility, or recurrent miscarriage Iron deficiency anemia Joint Pain Lymphocytic gastritis Malabsorption Malnutrition Muscle weakness Muscle wasting Nausea Obesity/Overweight Osteoporosis Pallor—pale, unhealthy appearance Panic Attacks Peripheral neuropathy Psychiatric disorders such as anxiety and depression Skin Problems—acne, eczema, DH, dry skin Stunted growth in children Underweight Vertigo Vitamin A deficiency Vitamin B6 deficiency Vitamin B12 deficiency Vitamin D deficiency Vitamin K deficiency Vomiting Voracious appetite Weight loss/gain Zinc deficiency Conditions Associated with Celiac Disease People with one or more of these associated conditions are at higher risk for celiac disease: Addison's Disease Anemia Anorexia Nervosa, Bulimia Arthritis Asthma Ataxia, Nerve Disease, Neuropathy, Brain Damage Attention Deficit Disorder Autism Bacterial Overgrowth Cancer, Lymphoma Candida Albicans Canker Sores—Aphthous Stomatitis) Casein / Cows Milk Intolerance Chronic Fatigue Syndrome Cognitive Impairment Crohn's Disease Depression Dermatitis Herpetiformis Diabetes Down Syndrome Dyspepsia, Acid Reflux Eczema Epilepsy Eye Problems, Cataract Fertility, Pregnancy, Miscarriage Fibromyalgia Flatulence—Gas Gall Bladder Disease Gastrointestinal Bleeding Geographic Tongue—Glossitis Growth Hormone Deficiency Hashimoto’s Thyroiditis Heart Failure Infertility, Impotency Inflammatory Bowel Disease Intestinal Permeability Irritable Bowel Syndrome Kidney Disease Liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis, etc.) Low bone density Lupus Malnutrition, Body Mass Index Migraine Headaches Multiple Sclerosis Myasthenia Gravis Celiac Disease Obesity, Overweight Osteopenia, osteoporosis, osteomalacia Psoriasis Refractory Celiac Disease & Collagenous Sprue Sarcoidosis Scleroderma Schizophrenia / Mental Problems Sepsis Sjogrens Syndrome Sleep Disorders Thrombocytopenic Purpura Thyroid & Pancreatic Disorders Tuberculosis Nutritional Deficiencies Associated with Celiac Disease and their Related Clinical Manifestations .divTable{ display: table; width: 100%; } .divTableRow { display: table-row; } .divTableHeading { background-color: #EEE; display: table-header-group; } .divTableCell, .divTableHead { border: 1px solid #999999; display: table-cell; padding: 3px 10px; min-width: 120px; } .divTableHeading { background-color: #EEE; display: table-header-group; font-weight: bold; } .divTableFoot { background-color: #EEE; display: table-footer-group; font-weight: bold; } .divTableBody { display: table-row-group; } Nutritional deficiency Most frequent signs and symptoms Iron Hypochromic, microcytic anemia, glossitis, koilonychia, fatigue, pallor, cognitive impairment Folate Megaloblastic anemia, glossitis, diarrhea, cognitive impairment Vitamin B12 Megaloblastic anemia, posterior columns syndrome, dementia, depression, psychosis Vitamin D Osteomalacia (deformity of bone, pathologic fractures), osteoporosis, cognitive impairment, secondary hyperparathyroidism Zinc Growth retardation, hypogonadism, infertility, dysgueusia, poor wound healing, diarrhea, dermatitis on the extremities and periorificial, glossitis, alopecia, corneal clouding Less frequently occurring Protein Edema, muscular atrophy Vitamin B1 (thiamine) Irritability, fatigue, headaches, peripheral neuropathy, wet Beriberi: congestive heart failure; Wernicke: nystagmus, ophtalmoplegia, ataxia; Korsakoff: hallucinations, impaired short-term memory and confabulation Vitamin B3 (niacin) Pellagra: diarrhea, dementia, pigmented dermatitis; Glossitis, stomatitis, vaginitis, vertigo, burning dysesthesias Vitamin B6 (pyridoxine) Stomatitis, angular cheilosis, glossitis, irritability, depression, confusion, normochromic normocytic anemia Vitamin A Follicular hyperkeratosis, night blindness, conjunctival xerosis, keratomalacia Vitamin E Hemolytic anemia, peripheral neuropathies, ophtalmoplegia, posterior columns syndrome Vitamin K Easy bleeding Top Scientific References on Celiac Symptoms University of Chicago Celiac Disease Center Mayo Clinic Celiac Disease Center Vitamin and Mineral Deficiencies Common in Newly Diagnosed Celiac Disease Patients Celiac Disease: Extraintestinal Manifestations and Associated Conditions

Celiac.com 02/18/2021 - There has been some evidence to support the idea that patients with anti-GAD ataxia and no gluten sensitivity may benefit form immunosuppressive drugs. A team of researchers recently set out to report the clinical characteristics and treatment of patients with progressive cerebellar ataxia associated with anti-GAD antibodies. The research team included M. Hadjivassiliou, P. G. Sarrigiannis, P. D. Shanmugarajah, D. S. Sanders, R. A. Grünewald, P. Zis & N. Hoggard. They are variously affiliated with the Academic Department of Neurosciences, and the Academic Department of Neuroradiology at the Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, in Sheffield, UK. The team conducted a retrospective review of all 50 patients with anti-GAD ataxia treated at the Sheffield Ataxia Centre over the last 25 years. The rate of anti-GAD ataxia was 2.5% amongst 2,000 patients with progressive ataxia of various causes. Average onset age was 55, with an average duration of 8 years. The researchers found gaze-evoked nystagmus in 26% of subjects, cerebellar dysarthria in 26%, limb ataxia in 44% and gait ataxia in all of them. Nine patients suffered from severe ataxia, 12 from moderate ataxia, and 29 from mild ataxia. Ninety percent of patients had a history other autoimmune diseases. Just over half had a family history of autoimmune diseases. In nearly three out of four patients, baseline MR spectroscopy of the vermis was abnormal at presentation. Thirty-five patients had positive serological evidence of gluten sensitivity. All 35 patients began a gluten-free diet (GFD). Eighteen patients, more than half, improved, while 13 patients stabilized, three patients began the GFD too recently to draw conclusions, and one patient got worse. Sixteen patients received mycophenolate. Seven patients, nearly 45%, improved, while two patients stabilized, six patients began the medication too recently to draw conclusions, and one did not tolerate the drug. There is considerable overlap between anti-GAD ataxia and gluten ataxia. For patients with both conditions, a strict GFD alone is sufficient treatment. However, patients with anti-GAD ataxia and no gluten sensitivity respond well to immunosuppression. Read more in The Cerebellum (2020)