Evolution of reproductive disorders related to celiac disease under gluten-free diet

Abstract

Introduction: Celiac disease (CD) is an autoimmune enteropathy induced by the ingestion of gluten (wheat, barley, rye). The classical form has become a minority. Currently, the most frequent forms of presentation are extradigestive with various manifestations, among others, reproductive disorders. The aim of our study is to assess the frequency of these disorders in CD and their evolution under gluten-free diet (GFD). Materials and methods: Descriptive retrospective study of 173 patients with CD followed in the department of diseases of the digestive tract "Médecine C" of the Ibn Sina Hospital in Rabat, over a period of 18 years. Result: In 173 patients with CD, 58 patients (28, 9%) had reproductive disorders. There are 53 women and 5 men. The average age was 32, 25 years. The diagnosis of CD is based on histology and serology. The Reproductive problems were never isolated but always associated with other digestive or extra-digestive signs at the time of diagnosis of CD. These disorders are represented by: delayed puberty in 11 patients (19%), secondary amenorrhea in 13 patients (22.4%), irregular menstrual in 12 patients (20.6%), absence of development of secondary sex characteristics in 8 patients (12.5%), spontaneous abortions in 7 patients (10.9%), menometrorrhagia in 4 patients (13.8%), primary sterility in 5 patients (8.6%), early menopause in 6 patients (10.3%), premature delivery in 3 patients (5%), primary amenorrhea in 2 patients (3.4%) and intrauterine fetal death in one case (1.7%). All our patients have had a GFD. 15 patients lost to follow-up, two patients died and 12 patients undergoing follow-up. The remaining 29 patients, the evolution of reproductive disorders under GFD was favorable in 26 patients (90%), with the normalization of cycles in 15 patients, resumption of cycles in 6 patients, development of secondary sex characteristics in 2 patients, fertility resumption in one case, initiation of cycles after primary amenorrhea in one case and delivery of a newborn at term after premature deliveries in one case. The evolution was unfavorable in 3 patients with the notion of miscarriage 4 years after the start of the GFD in one patient and the absence of cycle resumption in two patients. Conclusion: The reproductive disorders associated with CD are frequent and varied. In our study, these disorders responded very well under a GFD, conducted in 90%of patients. These disorders are thus reversible under this diet.