Editing Coeliac disease (section)

===Gastrointestinal===
[[diarrhea|Diarrhoea]] that is characteristic of coeliac disease is chronic, sometimes pale, of large volume, and abnormally foul in odor. [[Abdominal pain]], cramping, bloating with [[abdominal distension]] (thought to be the result of fermentative production of bowel gas), and [[mouth ulcer]]s<ref>{{cite journal | vauthors = Ferguson R, Basu MK, Asquith P, Cooke WT | title = Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration | journal = British Medical Journal | volume = 1 | issue = 6000 | pages = 11–13 | date = January 1976 | pmid = 1247715 | pmc = 1638254 | doi = 10.1136/bmj.1.6000.11 }}</ref> may be present. As the bowel becomes more damaged, a degree of [[lactose intolerance]] may develop.<ref name=Lancet2009/> This is because in addition to damage in the intestines, coeliac disease can cause a lactase deficiency, which is the enzyme that is responsible for breaking down lactose.<ref>{{cite journal |last1=Ojetti |first1=Veronica |last2=Nucera |first2=Gabriella |last3=Migneco |first3=Alessio |last4=Gabrielli |first4=Maurizio |last5=Lauritano |first5=Cristiano |last6=Danese |first6=Silvio |last7=Assunta Zocco |first7=Maria |last8=Nista |first8=Enrico Celestino |last9=Cammarota |first9=Giovanni |last10=de Lorenzo |first10=Antonino |last11=Gasbarrini |first11=Giovanni |last12=Gasbarrini |first12=Antonio |title=High Prevalence of Celiac Disease in Patients with Lactose Intolerance |journal=Digestion |date=2005 |volume=71 |issue=2 |pages=106–110 |id={{ProQuest|195196307}} |doi=10.1159/000084526 |pmid=15775678 }}</ref> Frequently, the symptoms are ascribed to [[irritable bowel syndrome]] (IBS), only later to be recognised as coeliac disease. In populations of people with symptoms of IBS, a diagnosis of coeliac disease can be made in about 3.3% of cases, or four times more likely than in general.<ref name=AJ2017>{{cite journal | vauthors = Irvine AJ, Chey WD, Ford AC | title = Screening for Celiac Disease in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis | journal = The American Journal of Gastroenterology | volume = 112 | issue = 1 | pages = 65–76 | date = January 2017 | pmid = 27753436 | doi = 10.1038/ajg.2016.466 | url = http://eprints.whiterose.ac.uk/106483/3/AJG-16-1318R1%20CLEAN.pdf }}</ref> Screening them for coeliac disease is recommended by the [[National Institute for Health and Clinical Excellence]] (NICE), the [[British Society of Gastroenterology]] and the [[American College of Gastroenterology]], but is of unclear benefit in North America.<ref name=AJ2017/><ref name=NICEIBS>{{NICE|61|Irritable bowel syndrome|2008}}</ref>

Coeliac disease leads to an increased risk of both [[adenocarcinoma]] and [[lymphoma]] of the small bowel ([[enteropathy-associated T-cell lymphoma]] (EATL) or other [[non-Hodgkin lymphoma]]s).<ref>{{cite journal | vauthors = Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, Fasano A | title = Celiac disease: a comprehensive current review | journal = BMC Medicine | volume = 17 | issue = 1 | pages = 142 | date = July 2019 | pmid = 31331324 | pmc = 6647104 | doi = 10.1186/s12916-019-1380-z | publisher = Springer Nature | doi-access = free }}</ref> This risk is also higher in first-degree relatives such as siblings, parents and children. Whether a gluten-free diet brings this risk back to baseline is not clear.<ref name=WJG2012>{{cite journal | vauthors = Gujral N, Freeman HJ, Thomson AB | title = Celiac disease: prevalence, diagnosis, pathogenesis and treatment | journal = World Journal of Gastroenterology | volume = 18 | issue = 42 | pages = 6036–6059 | date = November 2012 | pmid = 23155333 | pmc = 3496881 | doi = 10.3748/wjg.v18.i42.6036 | df = dmy-all | doi-access = free }}</ref> Long-standing and untreated disease may lead to other complications, such as [[Enteropathy-associated T-cell lymphoma#Ulcerative jejunitis|ulcerative jejunitis]] (ulcer formation of the small bowel) and stricturing (narrowing as a result of scarring with obstruction of the bowel).<ref name=AGA>{{cite journal | vauthors =  | title = American Gastroenterological Association medical position statement: Celiac Sprue | journal = Gastroenterology | volume = 120 | issue = 6 | pages = 1522–1525 | date = May 2001 | pmid = 11313323 | doi = 10.1053/gast.2001.24055 | doi-access = free }}</ref>