Original article—alimentary tractCeliac Crisis Is a Rare but Serious Complication of Celiac Disease in Adults
Section snippets
Methods
Because there are no standardized diagnostic criteria for celiac crisis, literature was first reviewed to define working criteria for case selection. Consensus among investigators was reached and celiac crisis was defined as follows: acute onset or rapid progression of gastrointestinal symptoms attributable to celiac disease requiring hospitalization and/or parenteral nutrition along with at least 2 objective signs of malnutrition, dehydration, or electrolyte disturbance (as listed in Table 1).
Results
Twelve adult patients with biopsy-proven celiac disease met the earlier-described criteria for celiac crisis. Because of the participating institutions' status as referral centers, actual incidence is difficult to estimate. However, between the 2 centers approximately 1200 patients with celiac disease were diagnosed over the study duration, reflecting an incidence of celiac crisis of less than 1% in patients with celiac disease.
Of the 12 cases, 8 were women and 4 were men, the mean age at
Discussion
Celiac disease is an immune-mediated enteropathy characterized by malabsorption and villous atrophy triggered by gluten proteins.13 Currently, in most adult cases, even untreated celiac disease has an indolent course with gastrointestinal symptoms and nutritional abnormalities, but does not result in severe or life-threatening illness. This is in stark contrast to the past when celiac disease was known as a severe disease of childhood. Although data do suggest that celiac disease is becoming
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Conflicts of interest The authors disclose no conflicts.
Funding This work was supported in part by the National Institutes of Health under the Ruth L. Kirschstein National Research Service Award/Training grant in Gastrointestinal Allergy and Immunology Research (T32 AI07047 to A.R.-T.) and National Institutes of Health grant (DK57892 to J.A.M.) as well as by internal funding from the Celiac Center at Beth Israel Deaconess Medical Center.