Manifestations Of Celiac Disease Research Articles

CELIAC DISEASE: NEW POSSIBILITIES FOR DIAGNOSIS AND MANAGEMENT

Вackground. Celiac disease is an autoimmune disease that occurs in genetically predisposed individuals and is characterized by damage to the mucous membrane of the small intestine due to exposure to gluten. The interest of researchers in gluten-associated diseases is growing every year. The true prevalence of celiac disease is not sufficiently studied due to the rarity of "classic" cases and the higher frequency of atypical and various clinical manifestations of this disease. Manifestation of celiac disease is possible at any age, the disease is more often diagnosed in adults. All this dictates the need to develop new algorithms for examining patients for timely detection and treatment of сеliacia. Aim: To review updated key consensus documents on the diagnosis and treatment of celiac disease. Matherials and methods. The results of scientific research related to celiac disease were searched. The studies that are included were selected based on searches in the online databases PubMed, Web of Science, Scopus, Google Scholar and others and relate to the basic methods of diagnosis and management of celiac disease. 110 sources were selected for analysis, of which were used that met the search criteria. Results. Based on the analysis of experimental and clinical studies, difficulties were identified in diagnosing celiac disease associated with a greater prevalence of extraintestinal manifestations and a rarity of "classical" cases. Methods of approach to the diagnosis of celiac disease in children and adults have been developed, taking into account invasiveness and accessibility. The basic approach in the treatment of celiac disease is a observed gluten-free diet. Regarding the selection of products, the individual characteristics of each patient are taken into account. Conclusion. To verify the diagnosis, adults and children with suspected celiac disease are recommended to perform esophagogastroduodenoscopy with biopsy of the duodenal mucosa at several points. An alternative method of diagnosis can be a combination of a very high level of antibodies of the imonoglobulin (Ig) A class to tissue transglutaminase (TGAs) and positive antibodies to endomysium (anti EMA) in two blood samples, however, no single analysis is 100% specific for celiac disease, and the diagnostic accuracy varies significantly between different laboratories. The only proven effective treatment for celiac disease is a lifelong gluten-free diet. In the absence of a complete clinical and serological response to diet, treatment goals are determined individually for each patient. The development of new treatments for celiac disease continues.

Atypical manifestation of celiac disease in carriers of HLA mutant gene

Annotation. Celiac disease is an autoimmune disease, which is manifested by enteropathy of the small intestine and is caused by the consumption of gluten-containing foods. According to statistics, the number of patients suffering from this disease has increased by 7.5% recently, which may be due to epigenetic factors and improvements in diagnostic methods of gluten intolerance. Human Leukocyte Antigen (HLA) gene plays a major role in the pathophysiological development of celiac disease. The function of HLA is an autoimmune response to endogenous and exogenous proteins. The pathogenesis of organ damage is based on an autoimmune reaction that occurs as a result of the entry of gliadin – the main component of gluten – into the organism. The influence of circulating immune complexes (CIC) leads to the appearance of typical and numerous atypical manifestations of the disease. This, in turn, significantly complicates the diagnosis and prescription of the correct treatment, which can ensure the restoration of the structure of the affected organs and improve the quality of life for patients. Atypical manifestations of gluten enteropathy are diverse, including chronic fatigue syndrome, damage to joints, bones, liver, male and female infertility, thyroid gland dysfunction, dermatitis, and tooth enamel structure disorders. Taking into account the importance of this issue, we conducted a systematic review and analysis of sources related to this question. The search was conducted in the scientometric databases PubMed, Google Scholar, Web of Science, Scopus, mostly over the last three years. In particular, it was found that screening for the specific HLA gene in first-degree relatives of patients with gluten enteropathy allows for an explanation of the exact etiology of possible atypical symptoms - manifestations of celiac disease, and subsequently prescribing a gluten-free diet that leads to the involution of the negative impact of the immune system on target organs. Moreover, this screening will be useful for identifying risk groups because manifestations of celiac disease could be in different ages and have different symptoms.

Cutaneous Manifestations in Celiac Disease: An Observational Study

Abstract Background: Cutaneous manifestations associated with celiac disease (CD), other than dermatitis herpetiformis, are poorly known. The aim of the present study was to study the spectrum of dermatological disorders in children with CD. Methodology: A total of 100 cases of biopsy-confirmed CD (both new and old) were recruited after taking written informed consent/assent from the child/guardians. The patient’s demographic details, history, vitals, general physical examination, systemic examination, and cutaneous examination findings were recorded. Relevant investigations were carried out, depending on the clinical findings of the cutaneous examination. Results: A total of 100 patients comprising 62 girls and 38 boys were studied, with the average age being 8.08 ± 3.67 years. Seventy patients showed the presence of dermatological findings. Cutaneous, mucosal, nail, and hair findings were seen in 35%, 7%, 14%, and 14% of patients, respectively. A higher incidence of dermatological findings was found in females (39%) compared to males (18%). The most common cutaneous conditions seen were atopic dermatitis (17%) and xerosis (10%). The most common mucosal finding was oral aphthae (4%). The most common nail changes were leukonychia and ragged cuticles (4% each). There was no statistical correlation between the presence of dermatological findings with the duration of the disease or with the duration of a gluten-free diet. Conclusion: Mucocutaneous manifestations are present in a significant proportion of patients with CD. Further studies with a larger sample size are needed to determine whether these findings are true associations or coincidental.

Uveitis as a Manifestation of Celiac Disease: A Population-Based Study

Introduction: The prevalence of celiac disease (CD) in the United States population has been estimated to be 0.71%, or 1 in 141, with the prevalence in first- and second-degree relatives of those affected being 4.55% and 2.59% respectively. Due to the multitude of ways in which this disease may initially present, it is important to screen for CD to avoid the potential consequences of inadequately managed disease. Many ophthalmic conditions have also been implicated as extraintestinal manifestations of CD, including uveitis. Despite several studies and case reports suggesting a positive correlation between CD and uveitis, there has yet to be a nationwide study in the United States quantifying this relationship. Therefore, the aim of this study is to conduct a large-scale multi-center population-based study to assess whether there is a statistically significant increased risk of uveitis in individuals with celiac disease. Methods: A validated multicenter and research platform database of more than 360 hospitals from 26 different healthcare systems across the United States consisting of data accumulated from 1999 to September 2022 was utilized to construct this study. We excluded patients with a history of autoimmune diseases, cataract surgery, or any type of eye infection. We included a subgroup of patients with a diagnosis of “uveitis” for further analysis. The risk of developing uveitis was calculated using a univariate logistic regression. A multivariate analysis was also done to account for confounding variables including African American ethnicity, male gender, sexually transmitted diseases, and celiac disease. Results: 70,632,440 patients were screened and a cohort of 46,895,750 individuals was selected for the final analysis after accounting for inclusion and exclusion criteria were met. The incidence of uveitis in patients with celiac disease in the past 3 years was 280 per 100,000 people. The prevalence of uveitis in the US population from 1999 to September 2022 was 150 per 100,000 people (0.15%). In order to adjust for confounding variables, a multivariate regression analysis was performed and showed an increased risk of being African-American (OR: 3.20%; 95% CI: 3.14-3.26) and male (OR: 1.13%; 95% CI: 1.12-1.16); and having a diagnosis of celiac disease (OR: 3.80%; 95% CI: 3.35-4.28) and sexually transmitted diseases (OR: 4.12%; 95% CI: 3.96-4.29) in patients with uveitis. Discussion: Recent population-based studies demonstrated that the prevalence of CD in the United States is much greater than previously thought, such that a trend of underdiagnoses is suspected to have occurred for several years. Many newly diagnosed uveitis cases, 48%, have been classified as idiopathic uveitis even after a complete workup was done. Several studies have been published in which a correlation between uveitis and CD is reported. The findings of this study further emphasize the importance of a thorough workup to evaluate for an underlying inflammatory process prior to diagnosing uveitis as idiopathic. Conclusion: In conclusion, we established that patients with celiac disease are at increased risk of developing uveitis after excluding and controlling for any confounding variables. In further studies, it could be interesting to investigate the impact of gluten-free diet in patients with celiac disease on the risk of developing uveitis.

Beyond the Gut: A Systematic Review of Oral Manifestations in Celiac Disease.

Celiac disease (CD) is a chronic immune-mediated gluten-sensitive enteropathy, affecting about 1% of the population. The most common symptoms include diarrhea, abdominal pain, weight loss, and malabsorption. Extra-intestinal symptoms include oral manifestations. This systematic review aims to catalog and characterize oral manifestations in patients with CD. a systematic literature review among different search engines using PICOS criteria has been performed. The studies included used the following criteria: tissues and anatomical structures of the oral cavity in humans, published in English and available in full text. Review articles and papers published before 1990 were excluded. 209 articles were identified in the initial search. In the end, 33 articles met the selection criteria. The information extracted from the articles was classified based on the type of oral manifestation. Recurrent aphthous stomatitis (34.6%), atrophic glossitis and geographic tongue (15.26%), enamel defects (42.47%), delayed dental eruption (47.34%), xerostomia (38.05%), glossodynia (14.38%), and other manifestations including cheilitis, fissured tongue, periodontal diseases, and oral lichen planus were found in the celiac subjects of the studies analyzed. The quality of articles on the topic should be improved; however, oral manifestations in CD patients are widely described in the literature and could help diagnose celiac disease.

Dental Manifestations and Celiac Disease-An Overview.

This review summarizes recent investigations on dental manifestations in celiac disease. Particular attention is paid to delayed dental eruption and maturity, dental enamel defects, molar incisor hypomineralization, dental caries, dental plaque, and periodontitis. Most studies confirmed a higher frequency of delayed dental eruption and maturation in children and dental enamel defects in children and adults with celiac disease compared to healthy individuals. The malabsorption of various micronutrients, especially calcium and vitamin D, as well as immunity, is considered the main cause of these conditions. An early diagnosis of celiac disease and introducing a gluten-free diet might prevent the development of these conditions. Otherwise, the damage has already been established, and it is irreversible. Dentists can play an important role in identifying people who may have unrecognized celiac disease and may help prevent its progress and long-term complications. Investigations on dental caries, plaque, and periodontitis in celiac disease are rare and inconsistent; these complaints need further examination.

HVOTO - An addition to the pandora box of extra-intestinal manifestations in celiac disease or just a trifling coincidence

HVOTO - An addition to the pandora box of extra-intestinal manifestations in celiac disease or just a trifling coincidence

Abstract #1318925: Femoral Neck Fracture as the First Manifestation of Celiac Disease

Celiac disease affects bone mineral metabolism by several mechanisms. The classic forms of celiac disease with evident malabsorption cause decreases in plasma calcium and vitamin D levels. These deficits lead to secondary hyperparathyroidism, which in turn increases the remodeling of the bone that result in decreased bone mass, changes the quality of bone, with the consequent decrease in strength of bone and increases the risk of fractures.

Вивчення проблеми забезпечення лікарськими засобами хворих на целіакію на засадах фармацевтичного права

Метою проведення авторами дослідження стало вивчення проблеми забезпечення лікарськими засобами хворих на целіакію на засадах фармацевтичного права. Як метод дослідження було використано комплексний підхід, що включав нормативно-правовий та документальний аналізи. Для наочності результати дослідження наведені у вигляді таблиці. Автори статті дослідили симптоматичні прояви целіакії, а також лікарські засоби, що застосовуються для її лікування. Результати дослідження свідчать про те, що існуючий асортимент готових лікарських засобів, що використовуються в комплексній терапії шкірних проявів целіакії, не може в повному обсязі задовольнити потребу в них, а також не дозволяє вирішити проблему індивідуальної непереносимості пацієнтом компонентів препарату. Авторами запропоновано екстемпоральний лікарський пропис, що дозволяє комбінувати в одній лікарській формі різні активні фармацевтичні інгредієнти з урахуванням індивідуальних особливостей пацієнта. Розроблена інструкція для медичного застосування та визначено режим контролю для даної екстемпоральної лікарської форми.

THE POTENTIAL USE OF ANTIBODIES FROM EGG YOLKS OF BIRD EGGS IN THE CONTEXT OF FOOD SECURITY OF THE RUSSIAN FEDERATION

Bering E. proposed the principle of passive immunization at the end of the 19th century. Today, it is still used to treat tetanus, diphtheria, botulism, rabies and poisonous animal bites (snakes, spiders and scorpions). As before, equine antibodies or their fragments are used as an antidote. But the unique properties of antibodies from the yolks of chicken eggs (IgY) make it possible to use them for a wide range of therapeutic and prophylactic purposes. IgY-antibodies are used in several countries (Canada, Germany, Japan, China) on an industrial scale to produce medical and veterinary drugs to protect humans and animals against pathogens, providing highly effective immunological protection. The Romanian Romvac Company SA is a separate company in the series of manufacturers of these drugs. This company produces IgY preparations in limited batches against many antigens and practices the production of personalized antibodies directed at pathogens of a particular patient. This approach is guaranteed to damage the pathogen, however unique it may be. The authors have analyzed many review articles on the use of IgY-technology. These antibodies are nonaddictive, non-toxic, do not interact with rheumatoid factor, complement, or Fc-fragments of immunocompetent cells, and do not cause antibody-dependent reinforcement of infection. Oral administration of specific IgY-antibodies significantly reduces the manifestations of celiac disease and pathological conditions caused by activation of pathogens in the gastrointestinal tract. Passive immunization of young farm animals with IgY-antibodies is economical and practical against many mammals, birds and aquatic animals. The great potential of this new direction can provide a rapid and cost-effective breakthrough in improving the adequate food security of the Russian Federation.

Заболевания слизистой оболочки полости рта и твердых тканей зубов как проявление целиакии

Celiac disease, or gluten-sensitive enteropathy, is a chronic autoimmune disease characterized by immune response when taking gluten. Celiac disease is a multifactorial disorder that results from the interaction of genetic and environmental factors. The review examines the etiology and pathogenesis of celiac disease from the view of the oral mucosal lesions. Based on the data of medical literature sources, the analysis of the incidence, severity and structure of oral cavity changes in celiac disease was conducted. It has been shown that tooth enamel defects and recurrent aphthous stomatitis may be the only manifestation of celiac disease The most common oral cavity disorders in celiac disease are recurrent aphthous stomatitis, teething retention, tooth enamel defects, in particular hypoplasia. Angular cheilitis and atrophic glossitis are considered the very rare. The caries prevalence in patients diagnosed with celiac disease either does not differ from the prevalence in healthy patients, or the caries prevalence indices are significantly lower in patients with celiac disease than in the control group. Oral lesions in celiac disease can cause significant functional and aesthetic disorders, as well as worsen the patient’s life quality. KEYWORDS: celiac disease, gluten enteropathy, oral mucosa, caries, recurrent aphthous stomatitis, teething retention, cheilitis, atrophic glossitis FOR CITATION: Mazurov V.I., Gaydukova I.Z., Inamova O.V. et al. Diseases of the oral mucosa and dental tissues as a manifestation of celiac disease. Russian Medical Inquiry. 2022;6(8):451–457 (in Russ.). DOI: 10.32364/2587-6821-2022-6-8-451-457.

Celiac Disease, Beyond the Bowel: A Review of Its Neurological Manifestations.

Celiac disease (CD) is a multi-systemic autoimmune condition that causes a hyperinflammatory response when gluten is ingested. There has been a shift in the clinical presentation of CD from a mere malabsorption disorder to an autoimmune condition that affects multiple organ systems, which could increase the rate of hospitalizations and a decreased quality of life. This article has compiled various studies that have explored the neurological manifestations of celiac disease, their epidemiology, possible pathogenic mechanisms, diagnosis, and treatment. The most common neurological conditions include gluten ataxia (GA), gluten neuropathy, gluten encephalopathy, and epilepsy which usually present as sporadic diseases which are difficult to diagnose in the absence of gastrointestinal (GI) symptoms. The treatment for most of these conditions is a gluten-free diet (GFD) regardless of GI involvement.

Acrodystrophic axonal polyneuropathy with celiac disease: a case report

BackgroundPatients with celiac disease present with not only gastrointestinal symptoms but also extraintestinal manifestations such as anemia, osteopathy, dermatitis herpetiformis, and celiac neuropathy. Despite a fairly wide range of celiac neuropathies, we report a case of the acrodystrophic variant of celiac polyneuropathy, which has not been previously described.Case presentationA 41-year-old Ukrainian male suffered from symmetric, sensorimotor axonal polyneuropathy and encephalopathy associated with celiac disease, which is characterized by severe trophic disorders in the lower extremities (trophic ulcers, hyperkeratosis, and anhidrosis). Acrodystrophic changes in the lower extremities were due to both neurogenic and direct immunoinflammatory damaging effects. Clinical–electrophysiological dissociation was also noted, which was represented by a gross axonal lesion with the preservation of muscle strength. The absence of enteropathic manifestations was accompanied by the pronounced histological changes in the duodenal mucosa by IIIb stage of Marsh. A gluten-free diet in combination with membrane plasma exchange and intravenous pulse methylprednisolone was prescribed to reduce the severity of sensory disorders and regression of encephalopathy within 7 months.ConclusionCeliac disease may be a potential cause of neuropathy and encephalopathy in adult patients. Further immunosuppressive treatment protocols for both intestinal and extraintestinal manifestations of celiac disease are required.

Overlap-синдром целіакії з атиповим аутизмом у дитини: клінічний випадок

У статті наведені дані літературних джерел і власне спостереження overlap-синдрому целіакії з атиповим аутизмом у дитини. Розглянуто питання етіопатогенетичного зв’язку глютензалежних захворювань і розладів аутистичного спектра. Проаналізовано особливості клінічного фенотипу у випадку поєднання шлунково-кишкових проявів целіакії та характерних для розладів аутистичного спектра симптомів. Акцентовано увагу на труднощах інтерпретації та оцінки гастроінтестинальних симптомів у хворих з психічними розладами. Обговорено послідовність проведення скринінгових тестів для виключення целіакії у хворих з розладами аутистичного спектра за наявності або відсутності гастроінтестинальної симптоматики.

Показатели физического развития детей с целиакией

Актуальность. Учитывая клинический полиморфизм целиакии, заболевание нередко в течение нескольких лет остается недиагностированным, что приводит к развитию серьезных изменений нутритивного статуса и задержки роста. Цель исследования: оценить физическое развитие детей и подростков на основании комплексного анализа антропометрических показателей в периоде клинической манифестации целиакии. Материалы и методы. Проанализированы результаты обследования 59 детей и подростков в возрасте от 6 месяцев до 18 лет с верифицированным диагнозом «целиакия». Антропометрические измерения проводились утром по общепринятым методикам. Данные антропометрических измерений детей оценивались по региональным стандартам. Рассчитывалось отклонение показателя длины тела относительно возраста (SDS длины тела), массы тела относительно длины тела (SDS массы тела). Статистическая обработка включала подсчет среднего арифметического значения каждого из показателей (М), среднего квад­ратичного отклонения (s), средней ошибки среднеарифметической (m), достоверности различий средних величин по t-критерию Стьюдента (р < 0,05). Результаты. Показатели физического развития детей с целиакией существенно отличались в зависимости от возраста верификации диагноза и продолжительности латентного периода заболевания. В структуре клинических проявлений у больных в остром периоде целиакии на первом месте находится задержка физического развития — 84,7 % человек. При этом в 76,3 % детей зарегистрирован дефицит массы тела: I степени — у 71,1%, II степени — у 22,2% и III степени — у 6,7 % случаев. Задержка роста установлена у 52,35 % детей: соматогенный нанизм обнаружен у 10,1 % больных, а низкорослость — у 42,3 % детей. Оценка стадии атрофии в соответствии с классификацией Marsh-Oberhuber показала, что у детей с более выраженной формой дефицита массы тела диагностирован тип Marsh 3C, тогда как при незначительном отставании показателей массы тела диагностированы типы Marsh 3A и Marsh 3В. Выводы. Антропометрические показатели пациентов с целиакией находятся в обратной зависимости от длительности латентного периода и возраста диагностики заболевания. У детей раннего возраста дефицит массы тела преобладает над задержкой роста, тогда как у старших детей отмечается замедление темпов роста с формированием низкорослости и соматогенного нанизма.

Celiac disease: non-carious lesions of the teeth

The high prevalence of non-carious manifestations in patients with celiac disease is described by numerous authors, who are considered as a diagnostic key to atypical forms of celiac disease. The manifestations closely associated with celiac disease include: defects in tooth enamel, pathological tooth abrasion, as a violation of the mineralization of dental crowns, and morphofunctional defects in the hard tissues of the teeth.Materials and methods. We examined 45 patients aged 23 to 36 years with a diagnosis of celiac disease, established on the basis of the results of clinical anamnestic, genetic, instrumental studies, morphological study of a biopsy specimen of the intestinal mucosa.Result. Examination of the dentition of the patients showed that 100% of the examined had pathological abrasion of tooth enamel. Crowded teeth were found in 32 patients. Partial symmetric congenital adentia was diagnosed in 5 patients.Conclusion. The revealed dentoalveolar anomalies can be attributed to oral manifestations of celiac disease, which is a diagnostic criterion for suspected disease.

Celiac disease and obesity: the possibility of comboridity of pathology in children

The article presents an analytical review of scientific research on celiac disease in children in different countries of the world. The prevalence of atypical manifestations of celiac disease has increased over the past two decades. A number of studies in children with celiac disease show that overweight / obesity at the onset of the disease is not uncommon. In addition, there is a tendency to develop overweight / obesity in patients with celiac disease who strictly adhere to a gluten-free diet. It has been shown that among obese children, the prevalence of celiac disease is comparable to the general population frequency. Thus, the diagnosis of celiac disease should be considered even in children with overweight / obesity, when this diagnosis can be easily missed.

Peripheral T-Cell Lymphoma Possibly Due to Unrecognized Celiac Disease in an Elderly Patient: A Case Report

Celiac disease (CD) is widely perceived as a childhood disorder. However, it has been demonstrated that 19–34% of new CD cases are diagnosed in patients over 60 years of age and lack the typical presentation. A 76-year-old female was admitted to the clinic due to a recurrent fever that had lasted over a year accompanied by progressive weakness, weight loss of about 10 kg, dehydration, and malnutrition. The patient had undergone resection of a fragment of the small intestine due to perforation and abscess 13 years previously (at which time no histopathological examinations were performed). During the current hospitalization, despite extensive laboratory, microbiological, and imaging tests, no specific diagnosis was made. Symptomatic treatment and empirical antibiotic therapy were conducted, but the patient died on the twenty-seventh day of hospitalization due to progressive respiratory failure. The autopsy revealed peripheral T-cell lymphoma in the mesentery of the small intestine, uterus, cecum, lung, and mediastinal lymph nodes. Based on the clinical picture, we believe that the lymphoma was induced by long-term, undiagnosed CD. Current knowledge allows us to see age-related differences in the manifestation of celiac disease and to be alert to the possible late-stage complications of the disease. The lack of awareness of how CD’s symptoms vary with age may lead to misdiagnosis and serious consequences of delayed diagnosis, including death.

Markedly elevated lipase as the first manifestation of celiac disease: Case Report

Lipase is a hydrolytic enzyme and commonly used for the diagnosis of pancreatitis with amylase. Except for pancreatitis, lipase is elevated in many clinical conditions such as hepatobiliary disorders, bowel diseases, malignancies, renal impairment. Celiac disease (CD) should be considered as one of the causes. In patients with CD, the frequency of pancreatic hyperenzymemia and possible pathophysiological mechanisms are not well studied. To date, several mechanisms explaining pancreatic hyperenzymemia in CD are reported. Malnutrition, disease bowel induced pancreatic dysfunction, autoimmune pancreatic inflammation, and macroenzymemia are the main ones. Herein, we report a patient with newly diagnosed CD, representing markedly elevated serum lipase level with normal amylase.

Clinical and Paraclinical Screening for Celiac Disease in Children with Intractable Epilepsy.

Background Celiac disease is the inflammatory entropy caused by hypersensitivity to gluten, which occurs in susceptible individuals. Some studies have suggested a link between celiac disease and epilepsy in children. Our aim was to screen for clinical and paraclinical features of celiac disease in children with intractable epilepsy. Methods This was a cross-sectional study. Children aged 2 to 18 years with refractory epilepsy that referred to the pediatric neurology clinic within one year (2018–2019) were enrolled. Demographic and clinical characteristics of patients, especially clinical manifestations of celiac disease, were recorded in a questionnaire. A venous blood sample was sent to determine the total IgA, anti-tTG (IgA), and anti-endomysial antibody (IgA). Endoscopy was performed in cases where the celiac serological test was positive. Results Seventy children with idiopathic drug-resistant epilepsy (44 boys) were evaluated. The height-for-age index was 49.2% and the weight-for-age index was 38.2% less than normal. Constipation (48.6%), anorexia (25.7%), and abdominal pain (21.4%) were the most common gastrointestinal symptoms. Celiac serological tests were negative in all children. Therefore, endoscopy and bowel biopsy were not performed in any case. Conclusion Celiac disease was not found in any patient with intractable epilepsy. Gastrointestinal symptoms and growth disorders in this group may be related to the underlying disease or medications and not to celiac disease.