Celiac crisis, a rare occurrence in adult celiac disease: A systematic review
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摘要
BACKGROUND Celiac crisis(CC), a potentially life-threatening condition, is one of the rare clinical presentations of celiac disease(CD). Several cases have been documented in the literature, mostly in children.AIM To perform a review of CC cases reported in adult CD patients.METHODS A systematic search of the literature was conducted in two databases,PubMed/MEDLINE and EMBASE, using the term "celiac crisis" and its variant"coeliac crisis", from January 1970 onwards. Altogether, 29 articles reporting 42 biopsy-proven cases were found in the search. Here, we summarized the demographic, clinical characteristics, laboratory and diagnostic work-ups, and therapeutic management in these patients.RESULTS Among the 42 CD cases, the median age was 50 years(range 23-83), with a 2:1 female to male ratio. The majority of patients(88.1%) developed CC prior to CDdiagnosis, while the remaining were previously diagnosed CD cases reporting low adherence to a gluten-free diet(GFD). Clinically, patients presented with severe diarrhea(all cases), weight loss(about two thirds) and, in particular situations, with neurologic(6 cases) or cardiovascular(1 case) manifestations or bleeding diathesis(4 cases). One in four patients had a precipitating factor that could have triggered the CC(e.g. trauma, surgery, infections). Laboratory workup of patients revealed a severe malabsorptive state with metabolic acidosis,dehydration, hypoalbuminemia and anemia. The evolution of GFD was favorable in all cases except one, in whom death was reported due to refeeding syndrome.CONCLUSION Celiac crisis is a rare but severe and potentially fatal clinical feature of CD. A high index of suspicion is needed to recognize this clinical entity and to deliver proper therapy consisting of supportive care and, subsequently, GFD.
BACKGROUND Celiac crisis(CC), a potentially life-threatening condition, is one of the rare clinical presentations of celiac disease(CD). Several cases have been documented in the literature, mostly in children.AIM To perform a review of CC cases reported in adult CD patients.METHODS A systematic search of the literature was conducted in two databases,PubMed/MEDLINE and EMBASE, using the term "celiac crisis" and its variant"coeliac crisis", from January 1970 onwards. Altogether, 29 articles reporting 42 biopsy-proven cases were found in the search. Here, we summarized the demographic, clinical characteristics, laboratory and diagnostic work-ups, and therapeutic management in these patients.RESULTS Among the 42 CD cases, the median age was 50 years(range 23-83), with a 2:1 female to male ratio. The majority of patients(88.1%) developed CC prior to CDdiagnosis, while the remaining were previously diagnosed CD cases reporting low adherence to a gluten-free diet(GFD). Clinically, patients presented with severe diarrhea(all cases), weight loss(about two thirds) and, in particular situations, with neurologic(6 cases) or cardiovascular(1 case) manifestations or bleeding diathesis(4 cases). One in four patients had a precipitating factor that could have triggered the CC(e.g. trauma, surgery, infections). Laboratory workup of patients revealed a severe malabsorptive state with metabolic acidosis,dehydration, hypoalbuminemia and anemia. The evolution of GFD was favorable in all cases except one, in whom death was reported due to refeeding syndrome.CONCLUSION Celiac crisis is a rare but severe and potentially fatal clinical feature of CD. A high index of suspicion is needed to recognize this clinical entity and to deliver proper therapy consisting of supportive care and, subsequently, GFD.
BACKGROUND Celiac crisis(CC), a potentially life-threatening condition, is one of the rare clinical presentations of celiac disease(CD). Several cases have been documented in the literature, mostly in children.AIM To perform a review of CC cases reported in adult CD patients.METHODS A systematic search of the literature was conducted in two databases,PubMed/MEDLINE and EMBASE, using the term "celiac crisis" and its variant"coeliac crisis", from January 1970 onwards. Altogether, 29 articles reporting 42 biopsy-proven cases were found in the search. Here, we summarized the demographic, clinical characteristics, laboratory and diagnostic work-ups, and therapeutic management in these patients.RESULTS Among the 42 CD cases, the median age was 50 years(range 23-83), with a 2:1 female to male ratio. The majority of patients(88.1%) developed CC prior to CDdiagnosis, while the remaining were previously diagnosed CD cases reporting low adherence to a gluten-free diet(GFD). Clinically, patients presented with severe diarrhea(all cases), weight loss(about two thirds) and, in particular situations, with neurologic(6 cases) or cardiovascular(1 case) manifestations or bleeding diathesis(4 cases). One in four patients had a precipitating factor that could have triggered the CC(e.g. trauma, surgery, infections). Laboratory workup of patients revealed a severe malabsorptive state with metabolic acidosis,dehydration, hypoalbuminemia and anemia. The evolution of GFD was favorable in all cases except one, in whom death was reported due to refeeding syndrome.CONCLUSION Celiac crisis is a rare but severe and potentially fatal clinical feature of CD. A high index of suspicion is needed to recognize this clinical entity and to deliver proper therapy consisting of supportive care and, subsequently, GFD.
引文
1 Bosca-Watts MM,Minguez M,Planelles D,Navarro S,Rodriguez A,Santiago J,Tosca J,Mora F.HLA-DQ:Celiac disease vs inflammatory bowel disease.World J Gastroenterol 2018;24:96-103[PMID:29358886 DOI:10.3748/wjg.v24.i1.96]
2 Rubio-Tapia A,Hill ID,Kelly CP,Calderwood AH,Murray JA;American College of Gastroenterology.ACG clinical guidelines:diagnosis and management of celiac disease.Am J Gastroenterol 2013;108:656-76;quiz 677[PMID:23609613 DOI:10.1038/ajg.2013.79]
3 Ludvigsson JF,Bai JC,Biagi F,Card TR,Ciacci C,Ciclitira PJ,Green PH,Hadjivassiliou M,Holdoway A,van Heel DA,Kaukinen K,Leffler DA,Leonard JN,Lundin KE,McGough N,Davidson M,Murray JA,Swift GL,Walker MM,Zingone F,Sanders DS;BSG Coeliac Disease Guidelines Development Group;British Society of Gastroenterology.Diagnosis and management of adult coeliac disease:guidelines from the British Society of Gastroenterology.Gut 2014;63:1210-1228[PMID:24917550 DOI:10.1136/gutjnl-2013-306578]
4 Freeman HJ.Endocrine manifestations in celiac disease.World J Gastroenterol 2016;22:8472-8479[PMID:27784959 DOI:10.3748/wjg.v22.i38.8472]
5 Husby S,Koletzko S,Korponay-SzabóIR,Mearin ML,Phillips A,Shamir R,Troncone R,Giersiepen K,Branski D,Catassi C,Lelgeman M,M?ki M,Ribes-Koninckx C,Ventura A,Zimmer KP;ESPGHANWorking Group on Coeliac Disease Diagnosis;ESPGHAN Gastroenterology Committee;European Society for Pediatric Gastroenterology,Hepatology,and Nutrition.European Society for Pediatric Gastroenterology,Hepatology,and Nutrition guidelines for the diagnosis of coeliac disease.J Pediatr Gastroenterol Nutr 2012;54:136-160[PMID:22197856 DOI:10.1097/MPG.0b013e31821a23d0]
6 Andersen DH,Di Sant'Agnese PA.Idiopathic celiac disease.I.Mode of onset and diagnosis.Pediatrics1953;11:207-223[PMID:13037440]
7 Di Sant'Agnese PA.Idiopathic celiac disease.II.Course and prognosis.Pediatrics 1953;11:224-237[PMID:13037441]
8 Ozaslan E,K?seo?lu T,Kayhan B.Coeliac crisis in adults:report of two cases.Eur J Emerg Med 2004;11:363-365[PMID:15542999 DOI:10.1097/00063110-200412000-00015]
9 Fasano A,Catassi C.Current approaches to diagnosis and treatment of celiac disease:an evolving spectrum.Gastroenterology 2001;120:636-651[PMID:11179241 DOI:10.1053/gast.2001.22123]
10 Tiwari A,Qamar K,Sharma H,Almadani SB.Urinary Tract Infection Associated with a Celiac Crisis:APreceding or Precipitating Event?Case Rep Gastroenterol 2017;11:364-368[PMID:28626385 DOI:10.1159/000475921]
11 Sood A,Midha V,Makharia G,Thelma BK,Halli SS,Mehta V,Mahajan R,Narang V,Sood K,Kaur K.A simple phenotypic classification for celiac disease.Intest Res 2018;16:288-292[PMID:29743842 DOI:10.5217/ir.2018.16.2.288]
12 de Almeida Menezes M,Cabral V,Silva Lorena SL.Celiac crisis in adults:a case report and review of the literature focusing in the prevention of refeeding syndrome.Rev Esp Enferm Dig 2017;109:67-68[PMID:26912167]
13 Gutiérrez S,Toro M,Cassar A,Ongay R,Isaguirre J,López C,Benedetti L.Celiac crisis:presentation as bleeding diathesis.Acta Gastroenterol Latinoam 2009;39:53-54[PMID:19408740]
14 Atikou A,Rabhi M,Hidani H,El Alaoui Faris M,Toloune F.Celiac crisis with quadriplegia due to potassium depletion as presenting feature of celiac disease.Rev Med Interne 2009;30:516-518[PMID:19249140 DOI:10.1016/j.revmed.2008.11.012]
15 Selen T,Ince M,Celik S,Cankurtaran RE KF.Gluten Sensitive Enteropathy Presenting with Celiac Crisis as the Initial Presentation:Case Report.Turkiye Klin J Gastroenterohepatol 2014;21:60-62[DOI:10.5336/gastro.2014-42592]
16 Jamma S,Rubio-Tapia A,Kelly CP,Murray J,Najarian R,Sheth S,Schuppan D,Dennis M,Leffler DA.Celiac crisis is a rare but serious complication of celiac disease in adults.Clin Gastroenterol Hepatol 2010;8:587-590[PMID:20417725 DOI:10.1016/j.cgh.2010.04.009]
17 Bardella MT,Fredella C,Saladino V,Trovato C,Cesana BM,Quatrini M,Prampolini L.Gluten intolerance:gender-and age-related differences in symptoms.Scand J Gastroenterol 2005;40:15-19[PMID:15841709 DOI:10.1080/00365520410008169]
18 Rowinski SA,Christensen E.Epidemiologic and therapeutic aspects of refractory coeliac disease-a systematic review.Dan Med J 2016;63:A5307[PMID:27910801]
19 Jinga M,Popp A,Balaban DV,Dima A,Jurcut C.Physicians'attitude and perception regarding celiac disease:A questionnaire-based study.Turk J Gastroenterol 2018;29:419-426[PMID:30249556 DOI:10.5152/tjg.2018.17236]
20 Dima A,Jurcut C,Manolache A,Balaban DV,Popp A,Jinga M.Hemorrhagic Events in Adult Celiac Disease Patients.Case Report and Review of the Literature.J Gastrointestin Liver Dis 2018;27:93-99[PMID:29557421 DOI:10.15403/jgld.2014.1121.271.cld]
21 Rostami K,Marsh MN,Johnson MW,Mohaghegh H,Heal C,Holmes G,Ensari A,Aldulaimi D,Bancel B,Bassotti G,Bateman A,Becheanu G,Bozzola A,Carroccio A,Catassi C,Ciacci C,Ciobanu A,Danciu M,Derakhshan MH,Elli L,Ferrero S,Fiorentino M,Fiorino M,Ganji A,Ghaffarzadehgan K,Going JJ,Ishaq S,Mandolesi A,Mathews S,Maxim R,Mulder CJ,Neefjes-Borst A,Robert M,Russo I,RostamiNejad M,Sidoni A,Sotoudeh M,Villanacci V,Volta U,Zali MR,Srivastava A.ROC-king onwards:intraepithelial lymphocyte counts,distribution&role in coeliac disease mucosal interpretation.Gut 2017;66:2080-2086[PMID:28893865 DOI:10.1136/gutjnl-2017-314297]
22 Hammami S,Aref HL,Khalfa M,Kochtalli I,Hammami M.Refeeding syndrome in adults with celiac crisis:a case report.J Med Case Rep 2018;12:22[PMID:29382373 DOI:10.1186/s13256-018-1566-6]
23 Gupta S,Kapoor K.Steroids in celiac crisis:doubtful role!Indian Pediatr 2014;51:756-757[PMID:25228621]
24 Al Shammeri O,Duerksen DR.Celiac crisis in an adult on immunosuppressive therapy.Can JGastroenterol 2008;22:574-576[PMID:18560637 DOI:10.1155/2008/453520]
25 Bul V,Sleesman B,Boulay B.Celiac Disease Presenting as Profound Diarrhea and Weight Loss-ACeliac Crisis.Am J Case Rep 2016;17:559-561[PMID:27492679 DOI:10.12659/AJCR.898004]
26 Forrest EA,Wong M,Nama S,Sharma S.Celiac crisis,a rare and profound presentation of celiac disease:a case report.BMC Gastroenterol 2018;18:59[PMID:29720096 DOI:10.1186/s12876-018-0784-0]
27 Chen A,Linz CM,Tsay JL,Jin M,El-Dika SS.Celiac Crisis Associated with Herpes Simplex Virus Esophagitis.ACG Case Rep J 2016;3:e159[PMID:27921058 DOI:10.14309/crj.2016.132]
28 Bou-Abboud C,Katz J,Liu W.Firing of an Implantable Cardiac Defibrillator:An Unusual Presentation of Celiac Crisis.ACG Case Rep J 2016;3:e137[PMID:27761475 DOI:10.14309/crj.2016.110]
29 Sbai W,Bourgain G,Luciano L,Brardjanian S,Thefenne L,Al Shukry A,Coton T.Celiac crisis in a multi-trauma adult patient.Clin Res Hepatol Gastroenterol 2016;40:e31-e32[PMID:26547137 DOI:10.1016/j.clinre.2015.10.003]
30 Yilmaz B,Aksoy EK,Kahraman R,Yaprak M,S?kgenc M,Dayan R,Eren I,Efe C.Atypical Presentation of Celiac Disease in an Elderly Adult:Celiac Crisis.J Am Geriatr Soc 2015;63:1712-1714[PMID:26289701 DOI:10.1111/jgs.13583]
31 Mrad RA,Ghaddara HA,Green PH,El-Majzoub N,Barada KA.Celiac Crisis in a 64-Year-Old Woman:An Unusual Cause of Severe Diarrhea,Acidosis,and Malabsorption.ACG Case Rep J 2015;2:95-97[PMID:26157925 DOI:10.14309/crj.2015.16]
32 Akbal E,Erba?G,Binneto?lu E,Güne?F,Bilen YG.An unusual gastric ulcer cause:celiac crisis.Wien Klin Wochenschr 2014;126:661-662[PMID:25234934 DOI:10.1007/s00508-014-0588-3]
33 Toyoshima MT,Queiroz MS,Silva ME,Corrêa-Giannella ML,Nery M.Celiac crisis in an adult type 1diabetes mellitus patient:a rare manifestation of celiac disease.Arq Bras Endocrinol Metabol 2013;57:650-652[PMID:24343635 DOI:10.1590/S0004-27302013000800011]
34 Parry J,Acharya C.Celiac crisis in an older man.J Am Geriatr Soc 2010;58:1818-1819[PMID:20863356 DOI:10.1111/j.1532-5415.2010.03052.x]
35 Krishna K,Krishna SG,Coviello-malle JM,Yacoub A,Hutchins LF.Celiac crisis in a patient with chronic lymphocytic leukemia and hypogammaglobulinemia.Clin Res Hepatol Gastroenterol 2011;35:70-73[PMID:20822871 DOI:10.1016/j.gcb.2010.08.002]
36 Kelly E,Cullen G,Aftab AR,Courtney G.Coeliac crisis presenting with cytomegalovirus hepatitis.Eur JGastroenterol Hepatol 2006;18:793-795[PMID:16772840 DOI:10.1097/01.meg.0000224471.28626.a6]
37 Chandan S,Ahmad D,Hewlett AT.Celiac Crisis:A Rare Presentation of Celiac Disease in Adults.Proceedings of the American College of Gastroenterology annual meeting 2016;2016 Oct 14-19;Las Vegas,USA.Las Vegas:American College of Gastroenterology 2016;[DOI:10.13140/RG.2.2.27883.54568]
38 de Leon LB,Becker SC da C,Appel-da-Silva MC,D’Incao RB,Tovo CV.Celiac crisis and hemorrhagic diathesis in an adult.Sci Med(Porto Alegre)2014;24:284-287
39 Ferreira R,Pina R,Cunha N,Carvalho A.A Celiac Crisis in an Adult:Raising Awareness to a LifeThreatening Condition.EJCRIM 2016;3[DOI:10.12890/2016_000384]
40 Magro R,Pullicino E.Coeliac crisis with severe hypokalaemia in an adult.Malta Med J 2012;24:36-39
41 Kizilgul M,Kan S,Celik S,Apaydin M,Ozcelik O,Beysel S,Cakal E,Ozbek M,Karaahmet F,Delibasi T.Celiac crisis in an adult type 1 diabetes mellitus patient presented with diarrhea,weight loss and hypoglycemic attacks.Int J Diabetes Dev Ctries 2017;37:85-87[DOI:10.1007/s13410-016-0477-6]
42 Gupta T,Mandot A,Desai D,Abraham P,Joshi A.Celiac crisis with hypokalemic paralysis in a young lady.Indian J Gastroenterol 2006;25:259-260[PMID:17090849]
43 Wolf I,Mouallem M,Farfel Z.Adult celiac disease presented with celiac crisis:severe diarrhea,hypokalemia,and acidosis.J Clin Gastroenterol 2000;30:324-326[PMID:10777199 DOI:10.1097/00004836-200004000-00026]
44 do Vale RR,Conci NDS,Santana AP,Pereira MB,Menezes NYH,Takayasu V,Laborda LS,da Silva ASF.Celiac Crisis:an unusual presentation of gluten-sensitive enteropathy.Autops Case Rep 2018;8:e2018027[PMID:30101133 DOI:10.4322/acr.2018.027]
2 Rubio-Tapia A,Hill ID,Kelly CP,Calderwood AH,Murray JA;American College of Gastroenterology.ACG clinical guidelines:diagnosis and management of celiac disease.Am J Gastroenterol 2013;108:656-76;quiz 677[PMID:23609613 DOI:10.1038/ajg.2013.79]
3 Ludvigsson JF,Bai JC,Biagi F,Card TR,Ciacci C,Ciclitira PJ,Green PH,Hadjivassiliou M,Holdoway A,van Heel DA,Kaukinen K,Leffler DA,Leonard JN,Lundin KE,McGough N,Davidson M,Murray JA,Swift GL,Walker MM,Zingone F,Sanders DS;BSG Coeliac Disease Guidelines Development Group;British Society of Gastroenterology.Diagnosis and management of adult coeliac disease:guidelines from the British Society of Gastroenterology.Gut 2014;63:1210-1228[PMID:24917550 DOI:10.1136/gutjnl-2013-306578]
4 Freeman HJ.Endocrine manifestations in celiac disease.World J Gastroenterol 2016;22:8472-8479[PMID:27784959 DOI:10.3748/wjg.v22.i38.8472]
5 Husby S,Koletzko S,Korponay-SzabóIR,Mearin ML,Phillips A,Shamir R,Troncone R,Giersiepen K,Branski D,Catassi C,Lelgeman M,M?ki M,Ribes-Koninckx C,Ventura A,Zimmer KP;ESPGHANWorking Group on Coeliac Disease Diagnosis;ESPGHAN Gastroenterology Committee;European Society for Pediatric Gastroenterology,Hepatology,and Nutrition.European Society for Pediatric Gastroenterology,Hepatology,and Nutrition guidelines for the diagnosis of coeliac disease.J Pediatr Gastroenterol Nutr 2012;54:136-160[PMID:22197856 DOI:10.1097/MPG.0b013e31821a23d0]
6 Andersen DH,Di Sant'Agnese PA.Idiopathic celiac disease.I.Mode of onset and diagnosis.Pediatrics1953;11:207-223[PMID:13037440]
7 Di Sant'Agnese PA.Idiopathic celiac disease.II.Course and prognosis.Pediatrics 1953;11:224-237[PMID:13037441]
8 Ozaslan E,K?seo?lu T,Kayhan B.Coeliac crisis in adults:report of two cases.Eur J Emerg Med 2004;11:363-365[PMID:15542999 DOI:10.1097/00063110-200412000-00015]
9 Fasano A,Catassi C.Current approaches to diagnosis and treatment of celiac disease:an evolving spectrum.Gastroenterology 2001;120:636-651[PMID:11179241 DOI:10.1053/gast.2001.22123]
10 Tiwari A,Qamar K,Sharma H,Almadani SB.Urinary Tract Infection Associated with a Celiac Crisis:APreceding or Precipitating Event?Case Rep Gastroenterol 2017;11:364-368[PMID:28626385 DOI:10.1159/000475921]
11 Sood A,Midha V,Makharia G,Thelma BK,Halli SS,Mehta V,Mahajan R,Narang V,Sood K,Kaur K.A simple phenotypic classification for celiac disease.Intest Res 2018;16:288-292[PMID:29743842 DOI:10.5217/ir.2018.16.2.288]
12 de Almeida Menezes M,Cabral V,Silva Lorena SL.Celiac crisis in adults:a case report and review of the literature focusing in the prevention of refeeding syndrome.Rev Esp Enferm Dig 2017;109:67-68[PMID:26912167]
13 Gutiérrez S,Toro M,Cassar A,Ongay R,Isaguirre J,López C,Benedetti L.Celiac crisis:presentation as bleeding diathesis.Acta Gastroenterol Latinoam 2009;39:53-54[PMID:19408740]
14 Atikou A,Rabhi M,Hidani H,El Alaoui Faris M,Toloune F.Celiac crisis with quadriplegia due to potassium depletion as presenting feature of celiac disease.Rev Med Interne 2009;30:516-518[PMID:19249140 DOI:10.1016/j.revmed.2008.11.012]
15 Selen T,Ince M,Celik S,Cankurtaran RE KF.Gluten Sensitive Enteropathy Presenting with Celiac Crisis as the Initial Presentation:Case Report.Turkiye Klin J Gastroenterohepatol 2014;21:60-62[DOI:10.5336/gastro.2014-42592]
16 Jamma S,Rubio-Tapia A,Kelly CP,Murray J,Najarian R,Sheth S,Schuppan D,Dennis M,Leffler DA.Celiac crisis is a rare but serious complication of celiac disease in adults.Clin Gastroenterol Hepatol 2010;8:587-590[PMID:20417725 DOI:10.1016/j.cgh.2010.04.009]
17 Bardella MT,Fredella C,Saladino V,Trovato C,Cesana BM,Quatrini M,Prampolini L.Gluten intolerance:gender-and age-related differences in symptoms.Scand J Gastroenterol 2005;40:15-19[PMID:15841709 DOI:10.1080/00365520410008169]
18 Rowinski SA,Christensen E.Epidemiologic and therapeutic aspects of refractory coeliac disease-a systematic review.Dan Med J 2016;63:A5307[PMID:27910801]
19 Jinga M,Popp A,Balaban DV,Dima A,Jurcut C.Physicians'attitude and perception regarding celiac disease:A questionnaire-based study.Turk J Gastroenterol 2018;29:419-426[PMID:30249556 DOI:10.5152/tjg.2018.17236]
20 Dima A,Jurcut C,Manolache A,Balaban DV,Popp A,Jinga M.Hemorrhagic Events in Adult Celiac Disease Patients.Case Report and Review of the Literature.J Gastrointestin Liver Dis 2018;27:93-99[PMID:29557421 DOI:10.15403/jgld.2014.1121.271.cld]
21 Rostami K,Marsh MN,Johnson MW,Mohaghegh H,Heal C,Holmes G,Ensari A,Aldulaimi D,Bancel B,Bassotti G,Bateman A,Becheanu G,Bozzola A,Carroccio A,Catassi C,Ciacci C,Ciobanu A,Danciu M,Derakhshan MH,Elli L,Ferrero S,Fiorentino M,Fiorino M,Ganji A,Ghaffarzadehgan K,Going JJ,Ishaq S,Mandolesi A,Mathews S,Maxim R,Mulder CJ,Neefjes-Borst A,Robert M,Russo I,RostamiNejad M,Sidoni A,Sotoudeh M,Villanacci V,Volta U,Zali MR,Srivastava A.ROC-king onwards:intraepithelial lymphocyte counts,distribution&role in coeliac disease mucosal interpretation.Gut 2017;66:2080-2086[PMID:28893865 DOI:10.1136/gutjnl-2017-314297]
22 Hammami S,Aref HL,Khalfa M,Kochtalli I,Hammami M.Refeeding syndrome in adults with celiac crisis:a case report.J Med Case Rep 2018;12:22[PMID:29382373 DOI:10.1186/s13256-018-1566-6]
23 Gupta S,Kapoor K.Steroids in celiac crisis:doubtful role!Indian Pediatr 2014;51:756-757[PMID:25228621]
24 Al Shammeri O,Duerksen DR.Celiac crisis in an adult on immunosuppressive therapy.Can JGastroenterol 2008;22:574-576[PMID:18560637 DOI:10.1155/2008/453520]
25 Bul V,Sleesman B,Boulay B.Celiac Disease Presenting as Profound Diarrhea and Weight Loss-ACeliac Crisis.Am J Case Rep 2016;17:559-561[PMID:27492679 DOI:10.12659/AJCR.898004]
26 Forrest EA,Wong M,Nama S,Sharma S.Celiac crisis,a rare and profound presentation of celiac disease:a case report.BMC Gastroenterol 2018;18:59[PMID:29720096 DOI:10.1186/s12876-018-0784-0]
27 Chen A,Linz CM,Tsay JL,Jin M,El-Dika SS.Celiac Crisis Associated with Herpes Simplex Virus Esophagitis.ACG Case Rep J 2016;3:e159[PMID:27921058 DOI:10.14309/crj.2016.132]
28 Bou-Abboud C,Katz J,Liu W.Firing of an Implantable Cardiac Defibrillator:An Unusual Presentation of Celiac Crisis.ACG Case Rep J 2016;3:e137[PMID:27761475 DOI:10.14309/crj.2016.110]
29 Sbai W,Bourgain G,Luciano L,Brardjanian S,Thefenne L,Al Shukry A,Coton T.Celiac crisis in a multi-trauma adult patient.Clin Res Hepatol Gastroenterol 2016;40:e31-e32[PMID:26547137 DOI:10.1016/j.clinre.2015.10.003]
30 Yilmaz B,Aksoy EK,Kahraman R,Yaprak M,S?kgenc M,Dayan R,Eren I,Efe C.Atypical Presentation of Celiac Disease in an Elderly Adult:Celiac Crisis.J Am Geriatr Soc 2015;63:1712-1714[PMID:26289701 DOI:10.1111/jgs.13583]
31 Mrad RA,Ghaddara HA,Green PH,El-Majzoub N,Barada KA.Celiac Crisis in a 64-Year-Old Woman:An Unusual Cause of Severe Diarrhea,Acidosis,and Malabsorption.ACG Case Rep J 2015;2:95-97[PMID:26157925 DOI:10.14309/crj.2015.16]
32 Akbal E,Erba?G,Binneto?lu E,Güne?F,Bilen YG.An unusual gastric ulcer cause:celiac crisis.Wien Klin Wochenschr 2014;126:661-662[PMID:25234934 DOI:10.1007/s00508-014-0588-3]
33 Toyoshima MT,Queiroz MS,Silva ME,Corrêa-Giannella ML,Nery M.Celiac crisis in an adult type 1diabetes mellitus patient:a rare manifestation of celiac disease.Arq Bras Endocrinol Metabol 2013;57:650-652[PMID:24343635 DOI:10.1590/S0004-27302013000800011]
34 Parry J,Acharya C.Celiac crisis in an older man.J Am Geriatr Soc 2010;58:1818-1819[PMID:20863356 DOI:10.1111/j.1532-5415.2010.03052.x]
35 Krishna K,Krishna SG,Coviello-malle JM,Yacoub A,Hutchins LF.Celiac crisis in a patient with chronic lymphocytic leukemia and hypogammaglobulinemia.Clin Res Hepatol Gastroenterol 2011;35:70-73[PMID:20822871 DOI:10.1016/j.gcb.2010.08.002]
36 Kelly E,Cullen G,Aftab AR,Courtney G.Coeliac crisis presenting with cytomegalovirus hepatitis.Eur JGastroenterol Hepatol 2006;18:793-795[PMID:16772840 DOI:10.1097/01.meg.0000224471.28626.a6]
37 Chandan S,Ahmad D,Hewlett AT.Celiac Crisis:A Rare Presentation of Celiac Disease in Adults.Proceedings of the American College of Gastroenterology annual meeting 2016;2016 Oct 14-19;Las Vegas,USA.Las Vegas:American College of Gastroenterology 2016;[DOI:10.13140/RG.2.2.27883.54568]
38 de Leon LB,Becker SC da C,Appel-da-Silva MC,D’Incao RB,Tovo CV.Celiac crisis and hemorrhagic diathesis in an adult.Sci Med(Porto Alegre)2014;24:284-287
39 Ferreira R,Pina R,Cunha N,Carvalho A.A Celiac Crisis in an Adult:Raising Awareness to a LifeThreatening Condition.EJCRIM 2016;3[DOI:10.12890/2016_000384]
40 Magro R,Pullicino E.Coeliac crisis with severe hypokalaemia in an adult.Malta Med J 2012;24:36-39
41 Kizilgul M,Kan S,Celik S,Apaydin M,Ozcelik O,Beysel S,Cakal E,Ozbek M,Karaahmet F,Delibasi T.Celiac crisis in an adult type 1 diabetes mellitus patient presented with diarrhea,weight loss and hypoglycemic attacks.Int J Diabetes Dev Ctries 2017;37:85-87[DOI:10.1007/s13410-016-0477-6]
42 Gupta T,Mandot A,Desai D,Abraham P,Joshi A.Celiac crisis with hypokalemic paralysis in a young lady.Indian J Gastroenterol 2006;25:259-260[PMID:17090849]
43 Wolf I,Mouallem M,Farfel Z.Adult celiac disease presented with celiac crisis:severe diarrhea,hypokalemia,and acidosis.J Clin Gastroenterol 2000;30:324-326[PMID:10777199 DOI:10.1097/00004836-200004000-00026]
44 do Vale RR,Conci NDS,Santana AP,Pereira MB,Menezes NYH,Takayasu V,Laborda LS,da Silva ASF.Celiac Crisis:an unusual presentation of gluten-sensitive enteropathy.Autops Case Rep 2018;8:e2018027[PMID:30101133 DOI:10.4322/acr.2018.027]