Symptoms of Celiac Disease
Celiac disease presents with a wide range of gastrointestinal and extraintestinal symptoms, with many patients experiencing non-classic presentations rather than the traditional symptoms of diarrhea, weight loss, and abdominal pain. 1
Gastrointestinal Symptoms
- Diarrhea is one of the most common classic symptoms of celiac disease, frequently accompanied by abdominal pain 1
- Weight loss or poor weight gain, particularly important in children, is a significant concern 1
- Bloating and flatulence are common complaints in patients with celiac disease 1
- Nausea and vomiting may occur in some patients 1
- Malabsorption leading to nutritional deficiencies is a common issue 1
- Some patients may experience alternating diarrhea and constipation, both of which typically respond to gluten elimination 2
Extraintestinal Symptoms
- Fatigue and weakness are common complaints, often related to anemia or general malnutrition 1
- Iron deficiency anemia that may be resistant to oral iron supplementation 1
- Growth failure in children is a significant concern 1
- Irritability and inability to concentrate, particularly noted in children 1
- Reproductive issues including infertility and recurrent miscarriages 1
- Abnormal liver function tests may be present 3
- Bone disease and decreased bone mineral density 4
- Skin disorders, including dermatitis herpetiformis (which is pathognomonic for celiac disease) 4, 5
- Neurological manifestations such as neuropathy 5
Special Considerations in Patients with Type 1 Diabetes
- Unpredictable blood glucose levels despite adherence to insulin regimen 6, 1
- Unexplained hypoglycemia episodes 6, 1
- Deterioration in glycemic control without obvious cause 6, 1
Clinical Presentation Patterns
- Classic presentation includes primarily gastrointestinal symptoms such as diarrhea, weight loss, and abdominal pain 1
- Silent or asymptomatic celiac disease may be diagnosed through screening of high-risk groups despite absence of symptoms 1
- Many patients present with non-specific or extraintestinal symptoms rather than classic gastrointestinal complaints, leading to delayed diagnosis 1
High-Risk Groups
- First-degree relatives of people with celiac disease 1
- Patients with type 1 diabetes (1-16% prevalence compared to 0.3-1% in general population) 6, 1
- Individuals with autoimmune thyroid disease 1
- Patients with Down syndrome 1
Clinical Pitfalls to Consider
- Only approximately 24% of those with celiac disease are diagnosed, creating a "celiac iceberg" of undiagnosed cases 1
- Symptoms may overlap with other gastrointestinal disorders such as irritable bowel syndrome, lactose intolerance, or microscopic colitis 1
- In children with type 1 diabetes, celiac disease may present with unpredictable blood glucose levels and unexplained hypoglycemia rather than classic gastrointestinal symptoms 6
- Patients on a gluten-free diet before testing may have false negative results on serological tests 1
- Many adult patients present with non-classic symptoms or extraintestinal manifestations rather than the traditional triad of diarrhea, steatorrhea, and weight loss 4
- Celiac disease can develop at any age, not just in childhood 4, 5