Two Abnormal Presentations of Celiac Disease in Obese, Premenopausal Women

Celiac Disease is a malabsorptive disorder of the small intestine that often presents with diarrhea as the most common symptom. Confirmatory diagnostic testing includes endoscopy, serologic testing, and biopsy of the small intestine. These two cases of Celiac Disease are unique because two women, mid-thirties and medically obese, presented with non-classic symptoms of CD. Patient A complained of recurrent upper abdominal discomfort and pain, while Patient B complained of persistent daily symptoms of nausea. Focal intraepithelial lymphocytes were present on small bowel biopsy for both patients. Villous atrophy consistent with Marsh Type 1 and Type 3 classification was also present on small bowel biopsy, for Patient A and Patient B, respectively. Both patients tested negative for Helicobacter pylori based on biopsy not through serology, yet the pattern of inflammation on gastric biopsy showed the possibility of H. pylori gastritis for Patient A.