From the Guidelines
The clinical manifestations of celiac disease (CD) include a wide range of gastrointestinal and extraintestinal symptoms, with the most common being chronic diarrhea, abdominal pain, bloating, weight loss, fatigue, and malnutrition, as reported in a recent study 1. Gastrointestinal symptoms are most common, particularly:
- Chronic or recurrent diarrhea
- Abdominal pain and cramping
- Bloating and gas
- Nausea and vomiting
- Constipation Other common manifestations include:
- Unexplained weight loss
- Fatigue and weakness
- Anemia (due to iron deficiency)
- Osteoporosis or osteopenia
- Skin rash (dermatitis herpetiformis)
- Neurological symptoms like headaches or neuropathy
- Reproductive issues such as infertility or miscarriages In children, additional signs may include:
- Failure to thrive
- Delayed growth and puberty
- Dental enamel defects It's essential to note that some people with celiac disease may be asymptomatic or have very mild symptoms, as highlighted in a systematic review with meta-analysis 1. The severity and range of symptoms can vary greatly between individuals. These manifestations occur because gluten triggers an immune response in the small intestine of people with celiac disease, leading to inflammation and damage to the intestinal lining, which interferes with nutrient absorption, causing many of the symptoms and nutritional deficiencies associated with the condition, as explained in a study on guidelines for best practices in monitoring established coeliac disease in adult patients 1.
The clinical presentation of CD can be diverse, and patients may present with a wide range of symptoms and signs, including anaemia, vague abdominal symptoms, neuropathy, ataxia, depression, adverse pregnancy outcomes, and lymphoma, as discussed in guidelines from the British Society of Gastroenterology 1. The diagnosis of CD is based on serology and duodenal biopsy, and the treatment is a lifelong, strict gluten-free diet, which can help alleviate symptoms, achieve mucosal healing, and prevent complications, as recommended in a recent study 1.
In summary, the clinical manifestations of celiac disease are diverse and can vary greatly between individuals, and a timely and accurate diagnosis is crucial to prevent complications and improve the quality of life of patients, as emphasized in a recent study 1.
From the Research
Clinical Manifestations of Celiac Disease
The clinical manifestations of celiac disease (CD) can vary widely, ranging from asymptomatic to full-blown symptoms due to the multi-system nature of the disease 2. The typical gastrointestinal (GI) manifestations of CD include:
- Abdominal pain
- Diarrhea
- Bloating
- Weight loss
Extra-Intestinal Manifestations
In addition to GI symptoms, CD can also present with extra-intestinal manifestations, including:
- Iron deficiency anemia
- Infertility/miscarriages
- Dermatitis
- Osteoporosis
- Elevated transaminase levels 3, 4
- Cutaneous and endocrinological disorders
- Abnormal liver function tests
- Neuropsychiatric features 5
Non-Classical Symptoms
Most adult patients with CD will present with non-classical symptoms, including less specific gastrointestinal symptoms or extra-intestinal manifestations such as anemia, osteoporosis, transaminitis, and recurrent miscarriage 6. Some patients may be asymptomatic, being diagnosed because of a positive family history or concomitant autoimmune hypothyroidism 3.
Malabsorption and Nutritional Deficiencies
CD can also lead to malabsorption of essential nutrients, resulting in nutritional deficiencies and poor nutritional status 2. This can have severe consequences, particularly in children, and can lead to delayed pediatric development 2.