Common Clinical Symptoms and Concomitant Disease in Celiac Patients – A Large Cohort Study in the North-East of Iran


  • Azita Ganji Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Kiarash Roustai Geraylow Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
  • Bijan Shahbazkhani Department of gastroenterology and Liver disease, Tehran University of Medical Sciences, Tehran, Iran.
  • Fahimeh Attarian Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.



Celiac disease, concomitant disease, main clinical symptoms


Objectives: This study aimed to provides an overview of large cohort focusing in different clinical symptoms and concomitant disease in CD patients.

Methods: Out of total 1,164 cases, 78.86% of cases were adults (mean age 29.67 ± 15.94) and sex ratio (f/m) was 2.40. Evaluated clinical characteristics included BMI, Marsh, TGA-IgA titer, main symptoms and concomitant disease.

Results: 96.86% of CD cases were seropositive anmore than 88% of patients had villous atrophy that 48.89% of them were type c. Dyspepsia 35.23%, diarrhea 18.52%, were main CD clinical symptoms. The common concomitant diseases were including nervous problems 57.43%, anemia 54.25%, osteopenia 28.23% and skin disease 23.54%.

Conclusion: the classic type is common type of CD in northeast Iran. Dyspepsia and diarrhea main clinical symptoms in these patients, consequence we recommended to screening for CD in cases whiteout classic symptoms (such as dyspepsia). Also recommended to screening for concomitant disease such as nervous problems, bon disease and anemia in female CD patients in first visit.  


1. Fedewa MV, Bentley JL, Higgins S, Kindler JM, Esco MR, MacDonald HV. Celiac Disease and Bone Health in Children and Adolescents: A Systematic Review and Meta-Analysis. J Clin Densitom. 2020;23(2):200-11.
2. Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, et al. Celiac disease: a comprehensive current review. BMC medicine. 2019;17(1):1-20.
3. Spijkerman M, Tan IL, Kolkman JJ, Withoff S, Wijmenga C, Visschedijk MC, et al. A large variety of clinical features and concomitant disorders in celiac disease–a cohort study in the Netherlands. Digestive and Liver Disease. 2016;48(5):499-505.
4. Lebwohl B, Sanders DS, Green PH. Coeliac disease. The Lancet. 2018;391(10115):70-81.
5. Dominguez Castro P, Harkin G, Hussey M, Christopher B, Kiat C, Liong Chin J, et al. Changes in Presentation of Celiac Disease in Ireland From the 1960s to 2015. Clinical Gastroenterology and Hepatology. 2017;15(6):864-71.e3.
6. Reilly NR, Fasano A, Green PH. Presentation of celiac disease. Gastrointestinal Endoscopy Clinics. 2012;22(4):613-21.
7. Lauret E, Rodrigo L. Celiac disease and autoimmune-associated conditions. BioMed research international. 2013;2013.
8. Neuhausen SL, Steele L, Ryan S, Mousavi M, Pinto M, Osann KE, et al. Co-occurrence of celiac disease and other autoimmune diseases in celiacs and their first-degree relatives. Journal of autoimmunity. 2008;31(2):160-5.
9. Stagi S, Giani T, Simonini G, Falcini F. Thyroid function, autoimmune thyroiditis and coeliac disease in juvenile idiopathic arthritis. Rheumatology. 2005;44(4):517-20.
10. Diamanti A, Capriati T, Bizzarri C, Panetta F, Ferretti F, Ancinelli M, et al. Celiac disease and endocrine autoimmune disorders in children: an update. Expert review of clinical immunology. 2013;9(12):1289-301.
11. Stein J, Schuppan D. Coeliac disease-new pathophysiological findings and their implications for therapy. Visceral Medicine. 2014;30(3):156-65.
12. Tio M, Cox MR, Eslick GD. Meta-analysis: coeliac disease and the risk of all-cause mortality, any malignancy and lymphoid malignancy. Alimentary Pharmacology & Therapeutics. 2012;35(5):540-51.
13. Ilus T, Kaukinen K, Virta LJ, Pukkala E, Collin P. Incidence of Malignancies in Diagnosed Celiac Patients: A Population-based Estimate. Official journal of the American College of Gastroenterology | ACG. 2014;109(9):1471-7.
14. Guandalini S, Assiri A. Celiac Disease: A Review. JAMA Pediatrics. 2014;168(3):272-8.
15. Mustalahti K, Catassi C, Reunanen A, Fabiani E, Heier M, McMillan S, et al. The prevalence of celiac disease in Europe: Results of a centralized, international mass screening project. Annals of Medicine. 2010;42(8):587-95.
16. Schuppan D, Zimmer K-P. The diagnosis and treatment of celiac disease. Deutsches Ärzteblatt International. 2013;110(49):835.
17. Tack GJ, Verbeek WH, Schreurs MW, Mulder CJ. The spectrum of celiac disease: epidemiology, clinical aspects and treatment. Nature reviews Gastroenterology & hepatology. 2010;7(4):204.
18. Gujral N, Freeman HJ, Thomson AB. Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World journal of gastroenterology: WJG. 2012;18(42):6036.
19. Kårhus LL, Gunnes N, Størdal K, Bakken IJ, Tapia G, Stene LC, et al. Influenza and risk of later celiac disease: a cohort study of 2.6 million people. Scand J Gastroenterol. 2018;53(1):15-23.
20. Odeh R, Alassaf A, Gharaibeh L, Ibrahim S, Khdair Ahmad F, Ajlouni K. Prevalence of celiac disease and celiac-related antibody status in pediatric patients with type 1 diabetes in Jordan. Endocr Connect. 2019;8(6):780-7.
21. Rönnblom A, Holmström T, Tanghöj H, Wanders A, Sjöberg D. Celiac disease, collagenous sprue and microscopic colitis in IBD. Observations from a population-based cohort of IBD (ICURE). Scand J Gastroenterol. 2015;50(10):1234-40.
22. Mohammadibakhsh R, Sohrabi R, Salemi M, Mirghaed MT, Behzadifar M. Celiac disease in Iran: a systematic review and meta-analysis. Electron Physician. 2017;9(3):3883-95.
23. Oberhuber G. Histopathology of celiac disease. Biomedicine & Pharmacotherapy. 2000;54(7):368-72.
24. Collin P, Vilppula A, Luostarinen L, Holmes GKT, Kaukinen K. Review article: coeliac disease in later life must not be missed. Alimentary Pharmacology & Therapeutics. 2018;47(5):563-72.
25. Vivas S, Vaquero L, Rodríguez-Martín L, Caminero A. Age-related differences in celiac disease: Specific characteristics of adult presentation. World J Gastrointest Pharmacol Ther. 2015;6(4):207-12.
26. Rampertab SD, Pooran N, Brar P, Singh P, Green PH. Trends in the presentation of celiac disease. The American journal of medicine. 2006;119(4):355. e9-. e14.
27. Volta U, Caio G, Stanghellini V, De Giorgio R. The changing clinical profile of celiac disease: a 15-year experience (1998-2012) in an Italian referral center. BMC Gastroenterology. 2014;14(1):194.
28. Petrarca L, Nenna R, Mastrogiorgio G, Florio M, Brighi M, Pontone S. Dyspepsia and celiac disease: Prevalence, diagnostic tools and therapy. World J Methodol. 2014;4(3):189-96.
30. Ford A, Ching E, Moayyedi P. Meta‐analysis: yield of diagnostic tests for coeliac disease in dyspepsia. Alimentary pharmacology & therapeutics. 2009;30(1):28-36.
31. Ghahramani R, Abbasian AS, Shafaee S. Prevelence of celiac disease in patients with different types of dyspepsia. Journal of Isfahan Medical School. 2009;27(93):65-73.
32. Green PHR. The many faces of celiac disease: Clinical presentation of celiac disease in the adult population. Gastroenterology. 2005;128(4, Supplement 1):S74-S8.
33. Schiepatti A, Sanders DS, Biagi F. Seronegative coeliac disease: clearing the diagnostic dilemma. Current opinion in gastroenterology. 2018;34(3):154-8.
34. Volta U, Caio G, Boschetti E, Giancola F, Rhoden KJ, Ruggeri E, et al. Seronegative celiac disease: Shedding light on an obscure clinical entity. Digestive and Liver Disease. 2016;48(9):1018-22.
35. Green PHR, Stavropoulos SN, Panagi SG, Goldstein SL, McMahon DJ, Absan H, et al. Characteristics of adult celiac disease in the USA: results of a national survey. The American Journal of Gastroenterology. 2001;96(1):126-31.
36. Salmi TT, Hervonen K, Kautiainen H, Collin P, Reunala T. Prevalence and incidence of dermatitis herpetiformis: a 40-year prospective study from Finland. British Journal of Dermatology. 2011;165(2):354-9.
37. Kahaly GJ, Frommer L, Schuppan D. Celiac disease and endocrine autoimmunity - the genetic link. Autoimmun Rev. 2018;17(12):1169-75.
38. Husby S, Koletzko S, Korponay-Szabó I, Kurppa K, Mearin ML, Ribes-Koninckx C, et al. European society paediatric gastroenterology, hepatology and nutrition guidelines for diagnosing coeliac disease 2020. Journal of pediatric gastroenterology and nutrition. 2020;70(1):141-56.
39. Ludvigsson JF, Bai JC, Biagi F, Card TR, Ciacci C, Ciclitira PJ, et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut. 2014;63(8):1210-28.
40. Roberta M, Federica G, Stefano K, Francesco DM, Fabiola F, Gioacchino L, et al. Thyroid and celiac disease in pediatric age: a literature review. Acta Bio Medica: Atenei Parmensis. 2018;89(Suppl 9):11.
41. Zhernakova A, Van Diemen CC, Wijmenga C. Detecting shared pathogenesis from the shared genetics of immune-related diseases. Nature Reviews Genetics. 2009;10(1):43-55.
42. Rubio-Tapia A, Murray JA. The Liver and Celiac Disease. Clin Liver Dis. 2019;23(2):167-76.
43. Hoffmanová I, Sánchez D, Tučková L, Tlaskalová-Hogenová H. Celiac Disease and Liver Disorders: From Putative Pathogenesis to Clinical Implications. Nutrients. 2018;10(7).
44. Cvetkovic L, Bernard G, Galette N, Hétu PO, Vincent C, Bouin M, et al. Discordance Between Serology and Histology for Celiac Disease in a Cohort with Coexisting Liver Disorders. J Can Assoc Gastroenterol. 2020;3(4):185-93.
45. Guedes NG, Silva LAd, Bessa CC, Santos JCd, Silva VMd, Lopes MVdO. Anxiety and depression: a study of psychoaffective, family-related, and daily-life factors in celiac individuals. Revista Brasileira de Enfermagem. 2020;73.
46. Häuser W, Janke K-H, Klump B, Gregor M, Hinz A. Anxiety and depression in adult patients with celiac disease on a gluten-free diet. World journal of gastroenterology: WJG. 2010;16(22):2780.
47. Audrey S, Procter S. Employers’ views of promoting walking to work: a qualitative study. International Journal of Behavioral Nutrition and Physical Activity. 2015;12(1):1-10.
48. Schøsler L, Christensen LA, Hvas CL. Symptoms and findings in adult-onset celiac disease in a historical Danish patient cohort. Scandinavian journal of gastroenterology. 2016;51(3):288-94.
49. Zanchetta MB, Longobardi V, Bai JC. Bone and Celiac Disease. Curr Osteoporos Rep. 2016;14(2):43-8.
50. Ganji R, Moghbeli M, Sadeghi R, Bayat G, Ganji A. Prevalence of osteoporosis and osteopenia in men and premenopausal women with celiac disease: a systematic review. Nutr J. 2019;18(1):9.




How to Cite

Ganji, A., Roustai Geraylow, K., Shahbazkhani, B., & Attarian, F. (2021). Common Clinical Symptoms and Concomitant Disease in Celiac Patients – A Large Cohort Study in the North-East of Iran. Journal of Contemporary Medical Sciences, 7(6).