From the Guidelines
Celiac disease is not always associated with diarrhea, as patients can present with a wide range of symptoms, including abdominal pain, bloating, constipation, vomiting, and even non-gastrointestinal manifestations. The clinical presentation of celiac disease has evolved over time, with a decrease in the proportion of newly diagnosed patients with classical malabsorptive symptoms, such as diarrhea and steatorrhea, and an increase in patients with non-classical symptoms, such as anaemia, vague abdominal symptoms, neuropathy, and depression 1. According to a recent study, symptoms of celiac disease may be gastrointestinal, such as diarrhea or constipation, or extra-intestinal, such as dermatitis herpetiformis, and not all symptoms carry similar sensitivity and specificity for the disease 1.
Key Points
- Celiac disease is an autoimmune condition that can present with a variety of symptoms, including gastrointestinal and non-gastrointestinal manifestations
- The condition is diagnosed through blood tests for specific antibodies and confirmed with intestinal biopsies
- Treatment involves strict adherence to a gluten-free diet, eliminating wheat, barley, and rye products
- The clinical presentation of celiac disease has evolved over time, with a decrease in classical malabsorptive symptoms and an increase in non-classical symptoms
Diagnosis and Treatment
The diagnosis of celiac disease involves a combination of clinical evaluation, serologic testing, and histologic analysis. The aim is to increase the prevalence of celiac disease in the tested population, where serologic testing and histologic analysis have an increased positive predictive value 1. Treatment of celiac disease involves a strict gluten-free diet, which allows the intestinal lining to heal and symptoms to resolve, regardless of whether diarrhea was initially present.
Quality of Life
The variety in presentation of celiac disease emphasizes the need for robust diagnostic criteria and careful disease work-up to improve the quality of life for patients with the condition. A gluten-free diet can significantly improve the quality of life for patients with celiac disease, reducing symptoms and preventing long-term complications, such as osteoporosis, anemia, and increased risk of certain cancers 1.
From the Research
Celiac Disease and Diarrhea
- Celiac disease is not always associated with diarrhea, as it can present with a wide range of gastrointestinal symptoms 2.
- Atypical presentations of celiac disease, which may not include diarrhea, appear to be at least as common as the classic presentation of steatorrhea, diarrhea, and weight loss 2.
- Some patients with celiac disease may experience silent celiac disease, which lacks diarrhea, but may present with manifestations such as irritable bowel syndrome, anemia, osteoporosis, neurologic diseases, or malignancy 3.
- Nondiarrheal presentations of celiac disease are now seen more commonly than those with diarrhea 3.
Variability in Symptoms
- Celiac disease can cause a wide range of gastrointestinal symptoms, including diarrhea, steatorrhea, abdominal pain, and bloating 2.
- Many patients with celiac disease have alternating diarrhea and constipation, both of which are responsive to a gluten-free diet 2.
- Extraintestinal manifestations of celiac disease, such as anemia, osteoporosis, and abnormal liver tests, can also occur in the absence of diarrhea 4, 5.
Diagnosis and Treatment
- Celiac disease diagnosis relies on serological tests, duodenal histology, and genetic testing, and can be challenging, particularly in seronegative patients or those who have started a gluten-free diet before diagnostic workup 4.
- The only proven treatment for celiac disease is a lifelong gluten-free diet, which can lead to substantial and rapid improvement of symptoms, including those other than diarrhea 2, 5.