Celiac disease is an underappreciated issue in women's health, according to Sveta Shah. Up to 8 percent of women with unexplained infertility may be affected, compared to about 1 percent of the general population.
Shah and colleagues at the Beth Israel Deaconess Medical Center in Boston, Massachusetts, explained that not everyone with celiac disease has the classical gastrointestinal symptoms.
Bloating, abdominal pain, bowel changes, and weight loss are common reactions to the consumption of grains containing gluten in celiac patients. However, “Celiac disease may be the cause of patients presenting at any age with nearly any complaint,” Shah reported.
According to Dr. Alberto Tommasini, of the Laboratory of Immunopathology, Institute for Maternal and Child Health Scientific Institute for Research and Care Burlo Garofolo and University of Trieste, other symptoms that may point to celiac disease include:
1. Iron deficiency anemia
2. Hyposplenism (reduced spleen function causing increased risk of infection)
3. Reduction in bone mass density
4. Liver function abnormalities
5. Neuropathy (nerve damage)
6. Psychological disturbances
8. Myalgias (muscle pain)
9. Arthralgias (joint pain)
11. Alopecia (hair loss)
13. Menstrual irregularities
14. Fertility problems
“Celiac disease is seldom considered in the evaluation of infertility, and the link between the two has been referred to many times in the literature as a 'neglected clinical association',” Shah reported, with the recommendation, “it is reasonable to suggest that all women with unexplained infertility be tested for CD [celiac disease].”
Blood tests for celiac disease are cost effective, according to Shah's paper. A duodenal biopsy can provide a confirming test.
The treatment is a gluten-free diet, which must be maintained for life. Wheat, rye, and barley are the primary sources of gluten in the average diet.
There is a range of gluten sensitivity, as described in a review by Alberto Tommasini and colleagues at the Laboratory for Immunopathology in Trieste, Italy. The number of diagnosed cases is increasing as the diagnostic tools improve. In addition, the gluten content of wheat has increased since the first celiac patients were identified in the ancient world.
Tommasini used the analogy of an iceberg to describe gluten intolerance. The tip of the iceberg represents the traditional diagnosis of celiac disease, with fatty diarrhea and severe digestive problems.
The much larger part of the iceberg under water represents the majority of gluten-sensitive individuals, who are more difficult to identify because their symptoms are atypical.
Both Shah and Tommasini recommended greater awareness of celiac disease and the potential benefits of the gluten-free diet for affected individuals.
Shah S, Leffler D, “Celiac disease: an underappreciated issue in women's health”, Womens Health (Lond Engl) 2010 September; 6(5): 753-66.
Tommasini A et al, “Ages of celiac disease: From changing environment to improved diagnostics”, World J Gastroenterol 2011 August 28; 17(32): 3665-71.
Reviewed April 23, 2012
by Michele Blacksberg RN
Edited by Jody Smith