SOURCE: Paez MA, Gramelspacher AM, Sinacore J, et al. Delay in diagnosis of celiac disease in patients without gastrointestinal complaints. Am J Med 2017:130:1318-1323.

Most clinicians think of celiac disease as primarily a gastrointestinal disorder. Hence, when patients present with typical symptoms (e.g., persistent non-acute abdominal pain, diarrhea) not explained by other disorders, identification of celiac disease by screening for anti-transglutaminase antibodies usually follows. But what about when the gastrointestinal symptom profile of celiac disease is not a prominent part of the picture? Manifestations of celiac disease can be as far reaching as anemia, osteoporosis, abnormal thyroid function tests, and abnormal liver function tests, none of which may produce an immediate prompt to consider celiac disease as the etiology.

Paez et al reviewed data on patients with biopsy-proven celiac disease (n = 101) treated at the Loyola University Medical Center. Patients who presented with gastrointestinal symptoms exhibited a median time to diagnosis of 2.3 months, compared to 42 months for those without gastrointestinal symptoms. While celiac disease certainly is not the most common cause of anemia, osteoporosis, abnormal liver function tests, or abnormal thyroid function tests, these results suggest that clinicians should think of celiac disease earlier in the differential diagnosis process, since the aforementioned consequences are largely remediable through appropriate dietary restrictions.