Some patients with GD have gastrointestinal symptoms caused by organomegaly, mainly early satiety, abdominal bloating, and stomach heaviness. These symptoms can be improved by dividing meals into smaller, more frequent portions and reducing food volume at each meal.

Celiac disease should be suspected and evaluated in case of persistent anemia, asthenia, abdominal pain, iron deficiency, or osteopenia with arthralgias. If so, a gluten-free diet can alleviate those symptoms and is the appropriate treatment. Non-celiac gluten sensitivity may be diagnosed upon exclusion of celiac disease in those patients who alleviate their symptoms and parameters with a gluten-free diet.

When available, food intolerances should be assessed with specific tests (such as lactose intolerance) or with challenge and re-challenge tests with the suspected food to ensure specific dietary restrictions are needed. Unnecessary dietary restrictions can be harmful to the patient in the long run and should be avoided.

Cholelithiasis is also frequent in patients with GD: an abdominal ultrasound should be performed if pain, gastralgia and bloating are frequently occurring.

 
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