Fatigue as an Extra-Intestinal Manifestation of Celiac Disease: A Systematic Review

Celiac disease may present with a range of different symptoms, including abdominal problems in a broader sense, iron deficiency and "constant tiredness". All of these symptoms should consequently lead the clinicians to consider celiac disease as a potential etiopathogenetic cause. Although the pathophysiology of celiac disease is well documented, the actual mechanisms for disease presentation(s) are less well understood. We here address the topic of fatigue in celiac disease. A systematic literature search identified 298 papers of which five met the criteria for full evaluation. None of the reviewed papers were of high quality and had several methodological weaknesses. We conclude that there is an unmet need to study the contributing factors and management of fatigue in celiac disease.