Presentation
We report a 12-year female who presented with simultaneous celiac disease and acute pancreatitis Case Presentation A 12-year girl was referred to the ER with one day history of severe epigastric abdominal pain and vomiting. [omicsonline.org]
Definition / general Enteropathy associated T cell lymphoma (EATL) is an intestinal tumor of intraepithelial T lymphocytes showing varying degrees of transformation but usually presenting as a tumor composed of large, often polymorphic lymphoid cells, [pathologyoutlines.com]
The cell of origin of indolent small intestinal CD4+ T-cell lymphomas is not known at present. [journals.plos.org]
Raynaud phenomenon is present in most patients with SSc and is often the earliest manifestation of disease. [emedicine.medscape.com]
Entire Body System
- Weight Loss
My primary care doctor said he was concerned about my weight loss. I had lost 10 pounds since my last visit. I didn’t need to lose the weight, and I hadn’t been trying to, either. [hhma.org]
loss, pallor, and periodic abdominal discomfort. [medbullets.com]
Young children most often show growth failure, weight loss, diarrhea, constipation or abdominal distension. [westchestergi.com]
[…] have increased secretions as does sprue • May be associated with pneumatosis intestinalis Whipple’s Disease • Glycoprotein in the lamina propria of the small bowel is Sudan-negative, PAS-positive • Clinically: arthralgia, abdominal pain, diarrhea and weight [learningradiology.com]
IBD manifests itself differently in different people, depending in part on the location and severity of the inflammation, but the primary symptoms are: abdominal pain; diarrhea (sometimes bloody); weight loss; fatigue; loss of appetite; rectal bleeding [ariahealth.org]
- Fatigue
The most common symptoms in adults include weight loss, chronic diarrhea, abdominal cramping, bloating and gas, muscle wasting, weakness, and fatigue. [westchestergi.com]
IBD manifests itself differently in different people, depending in part on the location and severity of the inflammation, but the primary symptoms are: abdominal pain; diarrhea (sometimes bloody); weight loss; fatigue; loss of appetite; rectal bleeding [ariahealth.org]
[…] health problems may include iron deficiency that results in a low number of red blood cells (anemia), vitamin deficiencies, low bone mineral density (osteoporosis), itchy skin rashes (dermatitis herpetiformis), defects in the enamel of the teeth, chronic fatigue [icdlist.com]
Its symptoms are diarrhea, anorexia, and fatigue. If the disease is prolonged, anemia caused by malabsorption of vitamin B 12 develops. Steatorrhea (excess fat in stools) is common, and glucose absorption is impaired. [britannica.com]
Notably, acrokeratosis neoplastica precedes the detection of malignancy in 65-70% of cases. [28] As such, when acrokeratosis neoplastica is suspected, a through history, focusing on cancer risk factors and symptoms, such as weight loss, malaise, and fatigue [emedicine.medscape.com]
- Malnutrition
This injury occurs to tiny fingerlike protrusions, called villi, which line the small intestine, and are critical in allowing absorption of nutrients and preventing malnutrition. [westchestergi.com]
However, there is no evidence to show improvement of pancreatitis, either by episode frequency or pain severity, after correction for malnutrition. [omicsonline.org]
It is characterized by INFLAMMATION of the SMALL INTESTINE, loss of MICROVILLI structure, failed INTESTINAL ABSORPTION, and MALNUTRITION. [icdlist.com]
Scarring often leads to bouts of vomiting and accompanying malnutrition and requires surgery. [britannica.com]
Cronkhite-Canada syndrome is fatal in about one half of patients, usually as a result of malnutrition or persistent diarrhea. [emedicine.medscape.com]
- Short Stature
Prevalence of celiac disease in Brazilian children of short stature. Braz. J. Med. Biol. Res. 37, 55–60 (2004). 100. Hyer, W., Cotterill, A. M. & Savage, M. O. Common causes of short stature detectable by a height surveillance programme. J. Med. [nature.com]
stature, which can occur when childhood celiac disease prevents nutrient absorption and seizures. [westchestergi.com]
- Fishing
"Plain" fish, meats, rice, fruits, and vegetables contain no gluten, so people with celiac disease can eat as much of these foods as they wish. The gluten-free diet is very challenging and requires a completely new approach to eating. [westchestergi.com]
In Japan gastric ulcer is more common than duodenal ulcer and is thought to be related to the raw fish and acetic acid pickles of the traditional diet. [britannica.com]
Gastrointestinal
- Diarrhea
Traveler’s diarrhea Traveler’s diarrhea is the abnormally swift passage of watery waste material through the large intestine, with consequent discharge of loose feces. Traveler’s diarrhea is accompanied by cramping and lasts a few days. [britannica.com]
Drugs to control diarrhea and intestinal spasms can sometimes help relieve cramps and diarrhea. Infusion with the monoclonal-antibody drug infliximab can help patients who have not gotten adequate response from other therapies. diet. [ariahealth.org]
• Does not have increased secretions as does sprue • May be associated with pneumatosis intestinalis Whipple’s Disease • Glycoprotein in the lamina propria of the small bowel is Sudan-negative, PAS-positive • Clinically: arthralgia, abdominal pain, diarrhea [learningradiology.com]
Young children most often show growth failure, weight loss, diarrhea, constipation or abdominal distension. [westchestergi.com]
Intestinal damage causes diarrhea and poor absorption of nutrients, which may lead to weight loss. Abdominal pain, swelling (distention), and food intolerances are common in celiac disease. [icdlist.com]
- Intestinal Disease
The lymphoma of immunoproliferative small intestinal disease (“Mediterranean” lymphoma) and the associated α-chain disease are also reviewed, with emphasis on the differences from the “Western” type of primary small intestinal lymphoma. [link.springer.com]
Malignant complications of celiac disease, such as enteropathy-associated T-cell lymphoma and small-intestinal adenocarcinoma, can be reliably investigated with cross-sectional enteroclysis techniques. [karger.com]
Erythema nodosum lesions usually parallel the intestinal disease, which provides helpful information on the overall disease. Histologically, the lesions are characterized by septal panniculitis. [emedicine.medscape.com]
- Constipation
Symptoms include abdominal discomfort, belching, flatulence, anorexia, nausea, vomiting, diarrhea, constipation, and heartburn. [britannica.com]
Young children most often show growth failure, weight loss, diarrhea, constipation or abdominal distension. [westchestergi.com]
Changes within the large intestine may result in chronic constipation, fecal impaction, and bowel obstruction. Involvement of the anal sphincter may lead to incontinence or even prolapse. [emedicine.medscape.com]
- Abdominal Cramps
The most common symptoms in adults include weight loss, chronic diarrhea, abdominal cramping, bloating and gas, muscle wasting, weakness, and fatigue. [westchestergi.com]
- Failure to Thrive
In junctional EB, failure to thrive and protein-losing enteropathy (PLE) were the prominent findings. Constipation was common in patients with dystrophic EB. [emedicine.medscape.com]
Jaw & Teeth
- Aphthous Ulceration
ulcers (sores in the mouth from vitamin deficiency), seizures, infertility, or behavioral changes. [westchestergi.com]
The association between celiac disease, dental enamel defects, and aphthous ulcers in a United States cohort. J. Clin. Gastroenterol. 44, 191–194 (2009). 143. Pastore, L. et al. Oral manifestations of celiac disease. J. Clin. [nature.com]
Oral lesions Mouth findings of patients with CD include findings such as angular cheilitis, aphthous ulceration, or mucosal cobblestoning. [emedicine.medscape.com]
Cardiovascular
- Vascular Disease
Diseases linked to Celiac Disease People with celiac disease may often have other autoimmune diseases such as thyroid disease, systemic lupus erythematosus (SLE), Type I diabetes, rheumatoid arthritis, Sjogren's syndrome, or collagen vascular diseases [westchestergi.com]
Vascular disease [ edit ] Ischemic enteritis is uncommon compared to ischemic colitis due to the highly vascularised nature of the small intestine, [12] allowing for sufficient blood flow in most situations. [en.wikipedia.org]
Risk of vascular disease in adults with diagnosed coeliac disease: a population-based study. Aliment. Pharmacol. Ther. 20, 73–79 (2004). 129. Wolf-Maier, K. et al. [nature.com]
Musculoskeletal
- Osteoporosis
Less commonly, people with celiac disease have joint pain, osteoporosis or osteopenia (low bone mass before osteoporosis), anemia (from impaired iron absorption), leg numbness (from nerve damage), muscle cramps (from impaired calcium absorption), aphthous [westchestergi.com]
Osteoporosis in a north american adult population with celiac disease. Am. J. Gastroenterol. 96, 112–119 (2001). 47. Kumar, M. et al. [nature.com]
These health problems may include iron deficiency that results in a low number of red blood cells (anemia), vitamin deficiencies, low bone mineral density (osteoporosis), itchy skin rashes (dermatitis herpetiformis), defects in the enamel of the teeth [icdlist.com]
What People with Celiac Disease Need to Know About Osteoporosis. From the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) [On-line information]. [labtestsonline.it]
- Fracture
Fracture experience of patients with coeliac disease: a population based survey. Gut 52, 518–522 (2003). 37. Logan, R. & West, J. Risk of fracture in coeliac disease. Gut 52, 1532 (2003). 38. Jafri, M. R. et al. [nature.com]
Other less common associated risks include: Cancers such as lymphoma and adenocarcinoma of the small intestine; Osteoporosis, a condition in which bones become brittle and are at risk for fracture; Miscarriage and congenital malformation of an affected [westchestergi.com]
- Osteopenia
Less commonly, people with celiac disease have joint pain, osteoporosis or osteopenia (low bone mass before osteoporosis), anemia (from impaired iron absorption), leg numbness (from nerve damage), muscle cramps (from impaired calcium absorption), aphthous [westchestergi.com]
Skin
- Ulcer
Among those who suffer from peptic ulcers, as many as 90 percent of those with duodenal ulcers and 70 percent with gastric ulcers are believed to be infected with H. pylori. [britannica.com]
Ulcerative colitis and Crohn's disease generally require long-term medical care. [ariahealth.org]
[…] to avoid perforation ( Case Rep Oncol 2009;2:36 ) Postulated normal counterpart Intraepithelial T cells of the intestine Gross description Multiple ulcerated mucosal masses, also single / multiple ulcers or large exophytic mass Gross images Images hosted [pathologyoutlines.com]
Impaired vitamin B 12 absorption Associated conditions: Autoimmune disorders Gastric polyps Gastric atrophy Gastric or duodenal ulcer Presentation Often asymptomatic Symptoms may include abdominal pain, bloating, reflux, nausea, vomiting. [clinicaladvisor.com]
My aspirin regimen, it seems, was irritating my ulcer, causing me to bleed internally. When we got the results back, they were negative for celiac disease. However, Dr. Newman wasn’t satisfied. [hhma.org]
- Skin Disease
What People with Celiac Disease Need to Know About Osteoporosis. From the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) [On-line information]. [labtestsonline.it]
- Pruritus
The lesions are associated with burning or pruritus and are limited to an acral distribution. [emedicine.medscape.com]
Psychiatrical
- Suggestibility
Nutritional supplements or special high-calorie liquid formulas may sometimes be suggested, especially for children with delayed growth. Large doses of vitamins are useless and may even cause harmful side effects. feeding through a vein. [ariahealth.org]
Lohan DG, Alhajeri AN, Cronin CG, Roche CJ, Murphy JM: MR enterography of small-bowel lymphoma: potential for suggestion of histologic subtype and the presence of underlying celiac disease. Am J Roentgenol 2008;190:287-293. [karger.com]
Newman suggested I have an endoscopy to see what was going on inside my digestive tract. He said he was curious if I had celiac disease, which I thought was kind of strange. [hhma.org]
[…] or in portal venous system Imaging • Spasm and irritability early is replaced by an atonic bowel later • Lumen is narrowed • Folds are thickened, sometimes producing “thumb-printing” • Healing may result in stricture formation Intramural Bleeding • Suggested [learningradiology.com]
Our findings, in conjunction with prior reports, suggest that these lymphomas represent a distinct entity. A comprehensive multimodality approach helps in diagnosis. [journals.plos.org]
Neurologic
- Confusion
Diagnosis The symptoms of celiac disease can be easily confused with those of other diseases such as irritable bowel syndrome, chronic fatigue syndrome, inflammatory bowel disease, or intestinal infections. [westchestergi.com]
Workup
Conclusions: Small bowel imaging and especially cross-sectional enteroclysis techniques are important extensions to the diagnostic workup of clinicians involved in the care of patients with celiac disease, especially those with suspected complicated disease [karger.com]
A thorough workup of the patient should also be done, with at least a chest radiograph, CBC count, and liver panel, but also other imaging directed by the patient’s symptoms. [emedicine.medscape.com]
Treatment
Incorporate the latest findings and improvements in care for liver disease patients —from diagnosis and treatment through post-treatment strategies and management of complications. Expert Consult eBook version included with purchase. [books.google.com]
[…] months after treatment. [en.wikipedia.org]
Most patients with IBD will not require surgery, a treatment typically reserved for those for whom drug therapy and other treatments have not been successful. [ariahealth.org]
Withdrawal of NSAID treatment usually allows the ulcer to heal. Treatment for H. pylori –induced ulcers are antibiotics and a proton pump inhibitor. [britannica.com]
However, the treatment of scurvy is simply food containing vitamin C. Therefore, the therapeutic challenge in scurvy is in identifying patients needing treatment. [emedicine.medscape.com]
Prognosis
[…] celiac disease diagnosed simultaneously with lymphoma in most patients Abdominal pain, often intestinal perforation, sometimes prodrome of refractory celiac disease accompanied by ulceration (ulcerative jejunitis - UJ) Prognostic factors Treatment and Prognosis [pathologyoutlines.com]
Occurrence and prognosis of extranodal lymphomas. Cancer 29 :252, 1972 Google Scholar 7. Novis, B.H.: Primary intestinal lymphoma in South Africa. Isr. J. Med. Sci. 15 :386, 1979 Google Scholar 8. [link.springer.com]
However, owing to the poor prognosis of glucagonomas, the outcome of this condition is also poor. [emedicine.medscape.com]
Diagnosis, management, and prognosis. J. Am. Acad. Dermatol. 64, 1027–1033 (2011). 59. Jaskowski, T. D. et al. IgA anti-epidermal transglutaminase antibodies in dermatitis herpetiformis and pediatric celiac disease. J. Invest. [nature.com]
Primary T/NK-cell lymphomas of the intestine are associated with a poor prognosis and a high risk of bowel perforation. [6] – [8] However, rare cases of primary GI indolent lymphoproliferative disorders of CD8+ and CD4+ T-cell lineages have been described [journals.plos.org]
Etiology
Higher frequency in areas with high prevalence of celiac disease (northern Europe) Monomorphic variant (type II EATL): 10% - 20% of cases of EATL, broader geographic distribution and sporadic occurrence in areas where celiac disease is rare (Asia) Etiology [pathologyoutlines.com]
Etiologies and predictors of diagnosis in nonresponsive celiac disease. Clin. Gastroenterol. Hepatol. 5, 445–450 (2007). 61. Ludvigsson, J. F., Lindelof, B., Zingone, F. & Ciacci, C. [nature.com]
Genetic susceptibility, anatomical abnormalities, medications, trauma, infectious etiologies and metabolic causes are the primary risk factors for pediatric pancreatitis. [omicsonline.org]
The etiology of indolent small intestinal CD4+ T-cell lymphomas is unclear. Persistent antigenic stimulation as a consequence of an immune-mediated or infectious disorder is a possibility. [journals.plos.org]
The cutaneous findings can be categorized into four main groups based on etiology. [emedicine.medscape.com]
Epidemiology
Epidemiological study by Ludvigsson et al. [ 5 ] has suggested that patients with celiac disease have a higher risk than the general population for the development of acute pancreatitis. [omicsonline.org]
Gluten ataxia in perspective: epidemiology, genetic susceptibility and clinical characteristics. Brain 126, 685–691 (2003). 70. Hadjivassiliou, M. et al. [nature.com]
[…] lymphoid cells, which are negative for CD56 Terminology Also called intestinal T cell lymphoma (with or without enteropathy), but many other T cell lymphomas can present with intestinal involvement ICD coding ICD-O: 9717 / 3 - intestinal T cell lymphoma Epidemiology [pathologyoutlines.com]
Communicable Disease Epidemiology and Control: A Global Perspective. CABI. ISBN 9781845935054. External links [ edit ] [en.wikipedia.org]
The Spectrum of Celiac Disease: Epidemiology, Clinical Aspects and Treatment. Medscape from Nat Rev Gastroenterol Hepatol. 2010;7(4):204-213. [On-line information]. Available online at http://www.medscape.com/viewarticle/720681. [labtestsonline.it]
Pathophysiology
Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management, Expert Consult Premium Edition - Enhanced Online Features. Elsevier Health Sciences. ISBN 978-1437727678. ^ Webber, Roger (2009-01-01). [en.wikipedia.org]
[…] most cases, NAE is associated with hepatitis C infection, [72] although several cases have occurred in patients without hepatitis C. [73, 74] Overall, it is a rare entity, with one study showing a prevalence 1.7% in patients with hepatitis C. [75] The pathophysiology [emedicine.medscape.com]
Prevention
When gluten is removed from the diet, symptoms improve, the small intestine begins to repair the existing damage, and further damage is prevented. [westchestergi.com]
"Radiation Enteropathy – Pathogenesis, Treatment, and Prevention". Nature Reviews. Gastroenterology & Hepatology. 11 (8): 470–479. doi : 10.1038/nrgastro.2014.46. ISSN 1759-5045. PMC 4346191. PMID 24686268. ^ Gregg, null; Nassar, null (1999-04-01). [en.wikipedia.org]
200 mg p.o. b.i.d. may decrease symptoms of gastritis Ursodeoxycholic acid (Actigall) 1,000 mg daily may decrease symptoms of bile reflux gastritis Various antioxidants and Chinese herbs reported to be beneficial in patients with chronic gastritis Prevention [clinicaladvisor.com]
No special diet has been proven effective for preventing or treating Crohn's disease. Certain symptoms are sometimes made worse by milk, alcohol, hot spices, or fiber, but this may not be true for everyone. [ariahealth.org]
Proton pump inhibitors, such as omeprazole, lansoprazole, and rabeprozale, inhibit the ATPase enzyme inside the parietal cell and prevent acid secretion. [britannica.com]