Clinical Features

• Chronic or recurring diarrhea: steatorrhea

• Flatulence, abdominal bloating, and pain

• Nausea/vomiting

• Lack of appetite

• Constipation (rarely)

• Malabsorption symptoms: fatigue, weight loss, vitamin deficiency, iron deficiency anemia, osteoporosis, hypocalcemia

• In children: failure to thrive, growth failure, delayed puberty

• Dermatologic associations: dermatitis herpetiformis

• Neuropsychiatric symptoms: peripheral neuropathies (numbness, burning and tingling of the hands and feet) , headache, ataxia, depression, irritability [4]

• Gynecological associations: reduced fertility or infertility

• Endocrine associations: autoimmune thyroid disease, type 1 diabetes mellitus

• Associated chromosomal syndromes: Turner syndrome, Down syndrome

• Other associated conditions: autoimmune hepatitis, irritable bowel syndrome, inflammatory bowel disease, rheumatoid arthritis, sarcoidosis, selective IgA deficiency

In both children and adults, mild or asymptomatic cases are more common than the classic presentation of the disease.