Abstract

Background

Celiac Disease (CD) is a common disorder that predominantly affects females. While typically thought of as a gastrointestinal (GI) disease, many CD patients present with a myriad of extraintestinal manifestations, leading to significant diagnostic challenges and morbidity, especially in patients manifesting subclinical and atypical presentations of CD.

Methods

A primary literature review was performed using the combined search terms: CD and autoimmunity, CD and infertility, CD and nutrition, as well as CD and osteopathic manipulative therapy (OMT) by interrogating PubMed, Google Scholar, and the Cochrane database. OMT information was supplemented by the textbooks Foundations of Osteopathic Medicine and Atlas of Osteopathic Techniques. 

Results

A malabsorptive phenotype leads to deficiencies in calcium, iron, and vitamins A, D, E, K, B9, and B12 and their associated disorders. Of these, the most concerning are anemia (>50% of CD patients at diagnosis) and osteoporosis (2.9% of female CD patients compared with 0.2% in non-CD female patients). Other manifestations include arthralgias (20–30% of CD patients) and hypothyroidism (3X more likely in CD patients). CD patients show an increased risk of infertility (25 fewer pregnancies/1000) and recurrent miscarriage (11 extra miscarriages/1000 pregnancies). Evidence shows improvement of these reproductive sequelae after a gluten-free diet. CD confers some protection against breast (hazard ratio (HR) = 0.85), endometrial (HR = 0.6), and ovarian (HR = 0.89) cancers.

Conclusion

This review highlights the impact of CD on female health and unique considerations when diagnosing and managing female CD patients. We also identify complementary OMT and nutritional considerations that can be used to manage female CD patients.