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Extraintestinal Manifestations of Celiac Disease: Effectiveness of the Gluten-Free Diet

Jericho, Hilary*; Sansotta, Naire; Guandalini, Stefano*

Journal of Pediatric Gastroenterology and Nutrition: July 2017 - Volume 65 - Issue 1 - p 75–79
doi: 10.1097/MPG.0000000000001420
Original Articles: Gastroenterology: Celiac Disease

Objective: The aim of the study was to evaluate the effectiveness of the gluten-free diet (GFD) on extraintestinal symptoms in pediatric and adult celiac populations at the University of Chicago.

Methods: We conducted a retrospective chart review of the University of Chicago Celiac Center clinic charts from January 2002 to October 2014. Demographics, serologic testing, intestinal biopsies, and extraintestinal symptoms at presentation, 12, 24, and >24 months were recorded. Extraintestinal symptoms included abnormal liver enzymes, arthralgia/arthritis, dermatitis herpetiformis, alopecia, fatigue, headache, anemia, stomatitis, myalgias, psychiatric disorders, rashes, seizures, neuropathy, short stature, delayed puberty, osteoporosis, and infertility.

Results: A total of 737 patients with biopsy-confirmed celiac disease or skin biopsy–confirmed dermatitis herpetiformis were included. Patients lost to follow-up, or with insufficient data were excluded leaving 328 patients (157 pediatrics younger than 18 years). For pediatrics, the female to male ratio was 2:1 and the mean age at diagnosis was 8.9 years. For adults, 4:1 and 40.6 years old. Extraintestinal symptom rates were similar in children (60%) and adults (62%). Short stature (33%), fatigue (28%), and headache (20%) were most common in children. Iron deficiency anemia (48%), fatigue (37%), and headache/psychiatric disorders (24%) were common in adults. Children had faster/higher rates of symptom resolution compared with adults. Twenty-eight percent of children with unresolved short stature on a GFD were found to have other comorbidities.

Conclusions: Children and adults with celiac disease have similar rates of extraintestinal manifestations. In children short stature, fatigue, and headache were most common, whereas anemia, fatigue, and headache/psychiatric disorders were most common in adults. Children on a strict GFD showed faster and higher rates of symptom resolution as compared to adults. Unresponsive children with short stature must be assessed for comorbidities.

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*Department of Pediatrics, University of Chicago Medicine Comer Children's Hospital, Chicago, IL

Department of Pediatrics, Università degli Studi di Verona, Verona, Italy.

Address correspondence and reprint requests to Hilary Jericho, MD, Division of Gastroenterology, Hepatology, Nutrition, The University of Chicago Medicine Comer Children's Hospital, 5721 S. Maryland Ave, Chicago, IL 60637 (e-mail:

Received 23 November, 2015

Accepted 19 September, 2016

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

There are no prior publications or submissions with significant overlapping information.

This work is not and will not be submitted to any other journal while under consideration by the Journal of Pediatric Gastroenterology and Nutrition.

The authors report no conflicts of interest.

© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,