Symptoms of Celiac Disease
Celiac disease presents with a wide range of gastrointestinal and extraintestinal symptoms, with diarrhea being the most common manifestation, though many patients present with atypical or non-classic symptoms. 1, 2, 3
Gastrointestinal Symptoms
- Diarrhea - Most common symptom, typically responds within days to weeks of gluten elimination 2, 4
- Abdominal pain - Common presentation that resolves with gluten-free diet 2, 4
- Bloating - Frequently reported and responsive to dietary changes 4
- Weight loss or poor weight gain - Particularly notable in children 1, 2
- Alternating diarrhea and constipation - Both responsive to gluten-free diet 4
- Nausea and vomiting - Common gastrointestinal manifestations 1
- Malabsorption - Can lead to nutritional deficiencies 3, 5
Extraintestinal Manifestations
- Fatigue - Common symptom that significantly impacts quality of life 1, 2
- Growth failure - Significant concern in pediatric patients 2
- Irritability - More commonly reported in children 2
- Cognitive symptoms - Including inability to concentrate 2
- Iron deficiency anemia - Common extraintestinal manifestation 3, 5
- Osteoporosis - Can occur due to malabsorption of calcium and vitamin D 3, 5
- Elevated liver enzymes (transaminitis) - May be present without other symptoms 3
- Dermatitis herpetiformis - Skin manifestation of celiac disease 1
Special Considerations in Patients with Type 1 Diabetes
Celiac disease occurs with increased frequency (1-16%) in patients with type 1 diabetes compared to the general population (0.3-1%) 1. Specific manifestations in these patients include:
- Unpredictable blood glucose levels 1, 2
- Unexplained hypoglycemia 1, 2
- Deterioration in glycemic control 1, 2
Atypical Presentations
It's important to note that atypical presentations of celiac disease are at least as common as the classic presentation of steatorrhea, diarrhea, and weight loss 4. These may include:
- Constipation rather than diarrhea 4, 5
- Recurrent miscarriage in women 3
- Poor growth without gastrointestinal symptoms, especially in children 5
Clinical Pitfalls and Caveats
- Many adult patients present with non-classic symptoms or extraintestinal manifestations rather than the typical triad of diarrhea, steatorrhea, and weight loss 3, 6
- Steatorrhea occurs in only about one-fifth of patients despite being considered part of the classic presentation 4
- Symptoms can develop at any age, not just in childhood 3
- Patients may be asymptomatic despite having intestinal damage 1
- The "celiac iceberg" phenomenon refers to the large number of undiagnosed patients due to non-specific or absent symptoms 1
Clinicians must maintain a high level of suspicion to detect atypical forms of celiac disease, particularly in high-risk groups such as first-degree relatives of celiac patients and those with other autoimmune conditions 3, 5.