From the Guidelines
The classic symptoms of celiac disease include gastrointestinal symptoms, such as diarrhea, nausea, vomiting, and abdominal pain, as well as extraintestinal symptoms like fatigue and weight loss. According to a systematic review with meta-analysis published in 2022 in the journal Alimentary Pharmacology and Therapeutics 1, these symptoms can vary in severity and presentation, making diagnosis challenging. The review highlights that symptomatic celiac disease is characterized by a range of symptoms, including:
- Gastrointestinal symptoms: diarrhea, nausea, vomiting, and abdominal pain
- Extraintestinal symptoms: fatigue and weight loss
- Other possible symptoms: iron-deficiency anemia, bone or joint pain, headaches, rashes, mouth ulcers, and neurological problems The review also notes that people with certain health conditions, such as type I diabetes, autoimmune thyroid disease, or Down syndrome, as well as first-degree relatives of people with celiac disease, are at higher risk of developing celiac disease and may present with non-classical symptoms 1. It is essential to consider these factors when evaluating patients with suspected celiac disease.
From the Research
Classic Symptoms of Celiac Disease
- Diarrhea
- Weight loss
- Abdominal pain
- Bloating
- Malabsorption
- Failure to thrive 2
Non-Classic Symptoms
- Anemia
- Osteoporosis
- Transaminitis
- Recurrent miscarriage 2
Extraintestinal Manifestations
- Iron deficiency anemia is considered one of the most frequent extraintestinal clinical manifestations of celiac disease 3
- Vitamin B12 deficiency is common in celiac disease and may be responsible for anemia and peripheral myeloneuropathy 3
- Folate deficiency is a well-known cause of anemia in adults 3
Diagnosis and Treatment
- Immunoglobulin A tissue transglutaminase serologic testing is the recommended initial screening for all age groups 2
- Esophagogastroduodenoscopy with small bowel biopsy is recommended to confirm the diagnosis in most patients 2
- A gluten-free diet for life is the primary treatment 2
- Patients with celiac disease who do not respond to a gluten-free diet should have the accuracy of the diagnosis confirmed, have their diet reassessed, and be evaluated for coexisting conditions 2
- Recovery from anemia occurs between 6 and 12 months on a gluten-free diet alone as a consequence of normalization of histological alterations of the intestinal mucosa 4