What are the implications of celiac disease (celiac disease) without gastrointestinal (GI) symptoms?

From the Guidelines

Celiac disease can present without gastrointestinal symptoms, and the treatment remains the same: strict adherence to a gluten-free diet for life. This condition is known as silent or atypical celiac disease, where patients may have no digestive complaints but still experience damage to their small intestine and other health problems. Common non-GI manifestations include iron deficiency anemia, osteoporosis, dermatitis herpetiformis (an itchy skin rash), neurological issues like headaches or peripheral neuropathy, reproductive problems, dental enamel defects, and fatigue 1.

Key Considerations

• The absence of digestive symptoms doesn't mean the disease is less serious; untreated celiac disease, even without GI symptoms, can lead to long-term complications including malnutrition, bone disease, certain cancers, and other autoimmune disorders.
• Patients should work with a dietitian to ensure proper nutrition while eliminating gluten, and regular follow-up with healthcare providers is essential to monitor for complications and ensure intestinal healing.
• Blood tests to check for celiac antibodies and nutritional deficiencies should be performed periodically, as the disease can be managed with a gluten-free diet, which can improve quality of life beyond other clinical benefits 1.
• Determination of urine and/or faecal gluten immunogenic peptides (GIPs) can be used to verify the correctness of the gluten-free diet, and the use of GIP determinations can help identify patients with persistent duodenal mucosal damage due to continuous gluten consumption at a low-moderate level 1.

Management and Follow-up

• The management and follow-up of patients with celiac disease is preferentially performed with a team-based approach, in which the dietician has an important role in the practical advice on lifestyle and choice of foods 1.
• A reasonable follow-up schedule will be every 12 months, and an open access or online service, perhaps aided with short message services (SMS), may improve adherence to the gluten-free diet.
• Lack of compliance with a gluten-free diet may lead to deterioration of quality of life, and long-term side effects of a gluten-free diet may be related to lack of vitamins and fiber in the diet 1.

Diagnosis and Monitoring

• The diagnosis of celiac disease is based on serology (TG2Ab) and duodenal biopsy while the patient is on a gluten-containing diet, and analysis of TG2Ab serum levels should be done as a first-line screening test 1.
• The use of serological tests, such as IgA anti-tissue transglutaminase (tTG) and IgA endomysial antibodies (EMA), can support the diagnosis of celiac disease, and intestinal biopsy is invasive and can be burdensome for patients, particularly children 1.

Conclusion is not allowed, so the answer will be ended here.

From the Research

Celiac Disease without GI Symptoms

• Celiac disease can present with a variety of manifestations, including nonclassic symptoms such as anemia, osteoporosis, transaminitis, and recurrent miscarriage 2
• Most adult patients with celiac disease will present with nonclassic symptoms, including less specific gastrointestinal symptoms or extraintestinal manifestations 2
• Celiac disease can develop at any age and may not always present with typical gastrointestinal symptoms such as diarrhea, weight loss, abdominal pain, and bloating 2
• Immunoglobulin A tissue transglutaminase serologic testing is the recommended initial screening for all age groups, and esophagogastroduodenoscopy with small bowel biopsy may be necessary to confirm the diagnosis 2

Diagnosis and Treatment

• A gluten-free diet for life is the primary treatment for celiac disease, and patients may benefit from support groups and education on common and hidden sources of gluten 2
• The gluten-free diet should be based on a combination of naturally gluten-free foods and certified processed gluten-free products, and should be nutrient-dense and balanced with macro- and micronutrients 3, 4
• Monitoring of the nutritional status using blood tests and use of appropriate gluten-free supplementation are integral components in the management of celiac disease 4
• A registered dietitian is necessary for patient education on the gluten-free diet and to help patients maintain a healthy weight and avoid disordered eating or diet hypervigilance 5

Challenges and Consequences

• The gluten-free diet may have a negative impact on quality of life for both celiac patients and their families, particularly for those with hypervigilance of the gluten-free diet and avoidance of dining out 5
• Weight gain and obesity have been added to the list of nutritional consequences while on the gluten-free diet, and have been partially attributed to the hypercaloric content of commercially available gluten-free foods 4, 5
• Gluten contamination is the most common cause of persistent symptoms in celiac disease, and shared equipment of food preparation may not be as large a problem as suspected 5