Atrophic Glossitis Leading to the Diagnosis of Celiac Disease

Diagnosing celiac disease is relatively easy in typical cases, characterized by the classic features of chronic diarrhea, abdominal pain and distention, and weight loss. However, most patients have atypical celiac disease, with few or no gastrointestinal symptoms and a predominance of extraintestinal features (e.g., iron-deficiency anemia). Patients with celiac disease are prone to the development of long-term complications (e.g., autoimmune diseases or cancers) that are responsible for a mortality rate higher than that in the general population.1 Gluten withdrawal seems to be protective against long-term complications, and it is the cornerstone of treatment for celiac disease. Case finding in subjects with clinical conditions known to be associated with celiac disease is currently the best epidemiologic approach to detecting atypical cases2; highly sensitive and specific serologic tests (for endomysial antibodies and tissue transglutaminase antibodies) are now available to screen at-risk patients. Although the natural history of celiac disease detected on screening remains unclear, at present, a gluten-free diet is deemed mandatory even for patients with atypical celiac disease; consequently, discovering the submerged part of the “celiac iceberg” is of the utmost importance.