**15. Liver disease in CD**

*Celiac Disease - From the Bench to the Clinic*

on gluten free diet [80].

carcinoma of the oropharynx.

in between and use of fluoride toothpaste.

**12. Reproductive complications in CD**

issues can be resolved with gluten free diet [81].

**13. Cardiac complications in CD**

**14. Autoimmune diseases in CD**

ity. All these can be resolved with gluten free diet [82].

gluten free diet with or without immunosuppressive therapy [83].

ulcers and delayed eruption of teeth [77]. The dental enamel defects are more common in deciduous dentition. It can involve all four quadrants, but more commonly involved maxillary and mandibular incisors and molars [78]. The exact cause is not understood but it may be due to increased level of HLA DR3 in their blood. This antigen has an association with celiac disease. Dental enamel hypoplasia, a nutritionally related defect of the enamel, presented as pits, lines or grooves on the teeth. Its prevalence ranges from 10 to 97%, and appears to more common in children with CD, as compared to adults [79]. Its prevalence in CD, is much higher than general population, and it is contributed both to nutritional and immunological factors. Another enamel defect, either partial or complete, can sometimes be the only symptoms in children with CD. It is thus advisable to screen children with enamel defects for CD. The other oral manifestation aphthous ulcer or canker sores are also seen in CD, though not specific for CD. Aphthous ulcers, though regresses

Delayed tooth eruption, another manifestation of CD, has been reported in 27% of patients with CD. The possible cause is probably malnutrition. A high prevalence of enamel hypoplasia is around 66% in CD patients. Formation of plaque is less frequent in patients who are on gluten free diet, probably because of multiple meals

There are other oral problem related to celiac disease, which include recurrent aphthous stomatitis, atrophic glossitis, dry mouth syndrome and squamous cell

Females with untreated CD may have multiple complications in relation to reproductive problems. They may have late menarche, recurrent miscarriages, infertility, preterm delivery and low birth weight. These patients may directly presented with these problems and do not have any gastrointestinal issues. All these

Males with CD also have infertility, characterized by sperm dysmotility and morphological changes. They may also have androgen resistance leading to infertil-

Autoimmune myocarditis and idiopathic dilated cardiomyopathy are associated with CD, though the prevalence is 5%. Not all patients have gastrointestinal symptoms but almost all of them iron deficiency anemia. These patients responded on

These patients also have strong association with ischemic heart disease as well.

CD is closely associated with other autoimmune illnesses, like type 1 diabetes mellitus and autoimmune thyroiditis. Type 1 diabetes mellitus and CD has strong genetic association with HLA-DR3, HLA-DQ2, and HLA-DQ8 [84]. Because of the same genetic association, they share same pathogenesis of tissue damage from autoimmunity or intolerance to dietary antigen. The patients with HLA-DQ2 also have raised IgA autoantibodies to tissue transglutaminase and thus likely to have CD with

**80**

CD may be associated with nonspecific mild chronic elevation in serum aminotransferase levels. AST ranges from 29 to 80 while ALT from 60 to 130. These increased transaminases may get normalize with gluten free diet. Patients with CD may also have severe liver disease including congenital liver fibrosis, massive steatosis, and progressive hepatitis of unknown origin [85]. There is also an association of primary biliary cirrhosis and primary sclerosing cholangitis with CD.
