title: Celiac crisis is a rare but serious complication of celiac disease in adults.
abstract: OBJECTIVE
  Celiac crisis is a life-threatening syndrome in which patients with celiac disease have profuse diarrhea and severe metabolic disturbances. Celiac crisis is rare among adults and not well documented. To improve awareness of this condition and to facilitate diagnosis, we reviewed cases of celiac crisis to identify presenting features, formulate diagnostic criteria, and develop treatment strategies.
  
  
  METHODS
  Cases of biopsy-proven celiac disease were reviewed. Celiac crisis was defined as acute onset or rapid progression of gastrointestinal symptoms that could be attributed to celiac disease and required hospitalization and/or parenteral nutrition, along with signs or symptoms of dehydration or malnutrition.
  
  
  RESULTS
  Twelve patients met preset criteria for celiac crisis; 11 developed celiac crisis before they were diagnosed with celiac disease. Eleven patients had increased titres of transglutaminase antibodies and 1 had immunoglobulin A deficiency. Results of biopsy analyses of duodenum samples from all patients were consistent with a Marsh 3 score (33% with total villous atrophy). Patients presented with severe dehydration, renal dysfunction, and electrolyte disturbances. All patients required hospitalization and intravenous fluids, 6 required corticosteroids, and 5 required parenteral nutrition. All patients eventually had a full response to a gluten-free diet.
  
  
  CONCLUSIONS
  Celiac crisis has a high morbidity and, although rarely described, occurs in adults and often has a clear precipitating factor. Patients who present with severe unexplained diarrhea and malabsorption should be tested for celiac disease; treatment with systemic steroids or oral budesonide should be considered. Nutritional support often is required in the short term but most patients ultimately respond to gluten avoidance.
authors.affiliation: Celiac Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA. shailajajamma@yahoo.com
authors.forename: Shailaja
authors.initials: S
authors.lastname: Jamma
authors.forename: Alberto
authors.initials: A
authors.lastname: Rubio-Tapia
authors.forename: Ciaran P
authors.initials: CP
authors.lastname: Kelly
authors.forename: Joseph
authors.initials: J
authors.lastname: Murray
authors.forename: Robert
authors.initials: R
authors.lastname: Najarian
authors.forename: Sunil
authors.initials: S
authors.lastname: Sheth
authors.forename: Detlef
authors.initials: D
authors.lastname: Schuppan
authors.forename: Melinda
authors.initials: M
authors.lastname: Dennis
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Leffler
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D019819:Budesonide / Q000627:therapeutic use; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D016638:Critical Illness / Q000453:epidemiology*; D003681:Dehydration / Q000209:etiology; D004032:Diet; D005260:Female; D041981:Gastrointestinal Tract / Q000473:pathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000209:etiology; D008875:Middle Aged; D010288:Parenteral Nutrition; D013256:Steroids / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D013256:Steroids; D019819:Budesonide