**12. Reproductive complications in CD**

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

Males with CD also have infertility, characterized by sperm dysmotility and morphological changes. They may also have androgen resistance leading to infertility. All these can be resolved with gluten free diet [82].

## **13. Cardiac complications in CD**

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

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

## **14. Autoimmune diseases in CD**

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

**81**

*Complications of Celiac Disease*

**15. Liver disease in CD**

**16. Skin manifestation in CD**

to general population [87].

and cardiovascular diseases [89].

**17. Mortality in CD**

type 111.

*DOI: http://dx.doi.org/10.5772/intechopen.80465*

helps in improvement of diabetes mellitus is not clear yet.

type 1 diabetes mellitus. Although age of onset of diabetes mellitus is not dependent of CD, neither it triggers the autoimmunity leading to it. Whether a gluten free diet

There is increased incidence of autoimmune thyroiditis among patients with CD, and hypothyroidism is more common. Association of CD, autoimmune thyroiditis and type 1 diabetes mellitus is part of polyglandular autoimmune syndrome

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

Dermatitis herpetiformis in CD is the commonest and pathognomonic skin lesion. It presents usually on external surface in grouped in the form intensely pruritic papules and vesicles. The diagnosis is confirmed on histology by the demonstration of granular IgA deposits along the non-affected subepidermal basement membrane [86]. Similar to CD they have increased antibodies against tissue transglutaminase IgG. Dermatitis herpetiformis and CD, are associated with HLA-DQ alpha beta heterodimers, and may have association with other autoimmune illness as well. It responds well on gluten free diet though requires longer duration.

Patients with CD, also have increased incidence of atopic dermatitis as compared

There is an increased mortality in patients with CD, due to severe clinical course but as a whole the data is inconclusive. There is twofold rise in death especially in severe disease [88]. The increased mortality is mostly associated with malignant

primary biliary cirrhosis and primary sclerosing cholangitis with CD.

### *Complications of Celiac Disease DOI: http://dx.doi.org/10.5772/intechopen.80465*

type 1 diabetes mellitus. Although age of onset of diabetes mellitus is not dependent of CD, neither it triggers the autoimmunity leading to it. Whether a gluten free diet helps in improvement of diabetes mellitus is not clear yet.

There is increased incidence of autoimmune thyroiditis among patients with CD, and hypothyroidism is more common. Association of CD, autoimmune thyroiditis and type 1 diabetes mellitus is part of polyglandular autoimmune syndrome type 111.
