Awareness of celiac disease (CD) has increased dramatically during the past 10 years in both the medical community and the general public. This is reflected by an increase in the number of patients diagnosed, an appreciation of the broader spectrum of clinical presentation, and an expanding array of gluten-free dietary alternatives and support resources for affected patients. Ob/gyns are most likely to encounter women with CD presenting with abdominal and pelvic pain. Irritable bowel syndrome and endometriosis are commonly part of the differential diagnosis.
Incidence and prevalence
Celiac disease is an inherited autoimmune chronic inflammatory intestinal disease that, uniquely, has a known inciting agent—gluten. People with other autoimmune diagnoses or genetic conditions such as Down syndrome, Turner syndrome, and Ehlers-Danlos syndrome have genetic susceptibility or predisposition loci and an increased incidence of CD. The risk of CD for a first-degree relative of a person with CD is 10% to 15%. It is 1.5 times to 2 times more common in women than men.1
Genetic susceptibility and exposure to gluten protein are necessary but not sufficient to cause loss of enteric function and CD. Celiac disease may resemble tropical sprue, a long-recognized malabsorption syndrome endemic to tropical locales, and was initially referred to as “celiac sprue.” Common symptoms include diarrhea; abdominal pain; malabsorption, with vitamin deficiencies; weight loss; hepatobiliary dysfunction; and fatigue. It is now recognized as a much more common malady than previously appreciated.
Different populations have substantial differences in prevalence of CD. It is more common in Scandinavian countries, southern Italy, North Africa, and the Mideast, and is relatively rare in Asia.1 One in 250 to 1 in 300 people are affected, with a spectrum of presentations including iron- and folate-deficient anemias, depression, herpetiformis dermatitis, and decreased bone mineral density.2-4 Rarer complications include refractory sprue, small intestinal adenocarcinoma, and enteropathy-associated T-cell lymphoma.