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Gastrointestinal symptoms in children

Because celiac sprue affects the absorption of nutrients essential for growth, children who are affected may have impaired growth and consequently short stature. Other common signs and symptomsinclude the following:

• Abdominal pain
  
  
• Vomiting
  
  
• Diarrhea
  
  
• Behavioral disturbances, including depression, irritability, and poor school performance

The onset of the symptoms is usually gradual and coincides with the introduction of cereal into the diet. The symptoms usually diminish in adolescence.

Gastrointestinal symptoms in adults

Celiac sprue usually affects adults in the third to fourth decade of lifebut sometimes later. The signs and symptoms of celiac sprue are variable and may include the following:

• Diarrhea
  
  
• Abdominal discomfort
  
  
• Bloating
  
  
• Steatorrhea, or fatty stools (caused by malabsorption of ingested fat)

Malabsorption of ingested fat results in the delivery of excessive dietary fat to the large bowel. The bacteria in the colon feast on the fats and other undigested and unabsorbed nutrients, generating intestinal gas resulting in bloating and flatulence. In addition, other substances are released, causing secretion of fluid into the intestine and hence diarrhea. Fatigue (tiredness) and weakness can result from the loss of electrolytes, such as potassium and magnesium, due to the diarrhea.

Nutrient and vitamin deficiencies

Iron and folic acid are essential for the production of normal red blood cells (erythrocytes). Abnormalities in the absorption of iron or folic acid may result inanemia (low red blood cell count). Vitamin B-12 deficiencies can also contribute to the anemia noticed in affected persons with a mechanism similar to that of iron and folic acid deficiencies.

Vitamin deficiencies may develop when malabsorption is present. Vitamins soluble in fat are commonly malabsorbed. These include vitamins K and D.

• Vitamin K is essential for the production of clotting proteins. As a result, vitamin K deficiency causes a bleeding tendency among persons with celiac sprue.
  
  
• Vitamin D is essential for the absorption of calcium, which is required for appropriate bone growth. As a result, vitamin D deficiency may cause low blood calcium levels (hypocalcemia). This predisposes children with celiac sprue to bone disorders such as rickets. Adults with celiac sprue have decreased calcium in the bones, a condition referred to as osteomalacia, and may develop fractures. Loss of protein andcalcium may lead to osteoporosis.

Nongastrointestinal (extraintestinal) features

Skin disorders can complicate the course of the celiac sprue. These conditions include dermatitis herpetiformis, an itchy skin condition characterized by a rash or blisters involving the extremities, the trunk, the buttocks, the scalp, and the neck.

Neurologic (nervous system) symptoms include weakness, problems with balance, and sensory changes (for example,sensation of touch and pain).

Hormonal disorders, such as loss of menstruation (amenorrhea) and infertility in women, and impotence andinfertility in men, are very uncommon.

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