Symptoms Assessment Tool

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Based upon Celiac Disease: Recognition, Assessment and Management, NICE guideline NG20

Celiac disease is a genetic, autoimmune condition in which eating gluten (a protein found in wheat, rye and barley) causes damage to the small intestine. You must be eating gluten regularly for the Symptoms Assessment Tool to be accurate. If you have unexplained symptoms or have a family member with celiac disease, complete the Symptoms Assessment Tool to see if you have an increased risk for celiac disease.

Family Members*
Do you have an immediate family member (parent, sibling, child) with celiac disease?
- Yes
- No
- Unsure
Diet*
Are you on a strict gluten-free diet (no ingestion of wheat, rye, or barley)?
- Yes
- No
General Conditions*
Please select all that apply.
- Unexplained anemia - Iron-deficient anemia (low red blood cell count or low hemoglobin) is one of the most common symptoms in older children and adults with celiac disease due to intestinal damage from ingesting gluten which prevents the body from absorbing nutrients. In children, folate deficiency can also cause anemia. Vitamin B12, B6, pantothenic acid, riboflavin and copper deficiencies also contribute to anemia in celiac disease.
- Fatigue or chronic fatigue syndrome - Fatigue (tiredness or persistent tiredness not helped by rest) is the most common symptom reported by people with celiac disease when they ingest gluten. The reason for fatigue is not clear, but could be related to malnutrition due to the body's inability to absorb nutrients. It is also a symptom of anemia.
- Failure to thrive - Failure to thrive in children (usually growth below the 3rd or 5th percentiles or a fall in growth from above the 75th percentile to below the 25th percentile in a short time) is a result of malnutrition in celiac disease.
- IgA deficiency - IgA deficiency (low immunoglobulin A (IgA) in blood serum) results when the body does not make sufficient IgA antibodies to fight infections in the body. It is associated with celiac disease and can cause a false negative on the tTG-IgA celiac blood test.
- Malnutrition or vitamin deficiency - Malnutrition and vitamin deficiency (lack of nutrients or low vitamin and mineral levels) are common in undiagnosed people with celiac disease due to intestinal damage from ingesting gluten which results in the body's inability to absorb nutrients. Iron, calcium, and Vitamin D are the most common deficiencies. B12, copper, folate, magnesium, niacin, riboflavin, and zinc deficiencies are less common.
- None of the above
Behavioral or Central Nervous System Conditions*
Please select all that apply.
- ADHD - Attention deficit hyperactivity disorder (inattentiveness, impulsivity, and hyperactivity) has been reported to be "markedly overrepresented" in undiagnosed people with celiac disease, with symptoms improving after six months on a gluten-free diet.
- Anxiety - Anxiety and panic disorders (overreacting feelings of fear, stress, or uneasiness) are associated with celiac disease, with symptoms improving after one year on a gluten-free diet.
- Ataxia (lack of muscle coordination) - Gluten ataxia (inability to control movement or balance very well caused by gluten ingestion) causes damage to the cerebellum, which is the part of the brain that controls coordination. It can be caused by vitamin B12 and E deficiencies.
- Brain fog or foggy mind - Brain fog (disorientation, problems with staying focused and paying attention, and lapses in short-term memory) is commonly reported by people with celiac disease after gluten ingestion.
- Depression - Depression and mood disorders (persistent feelings of hopelessness, irritableness, uncontrollable negative thoughts, seeking reckless behavior, sleeping too much or not enough, loss of appetite or eating too much) is common among people with celiac disease. Some improve on a gluten-free diet, while others are diagnosed with subsequent depression.
- Developmental delay - Development delays (not reaching developmental milestones at expected times) can be found in children with celiac disease due to malnutrition from intestinal damage caused by gluten consumption.
- Headache or migraine - Headache or migraine (pain in the region of the head or neck from tissues surrounding the brain/throbbing, disabling head pain, often accompanied by light sensitivity, fatigue, nausea and even vomiting) can be triggered by the ingestion of gluten in nearly 30% of people with celiac disease. Studies show that a gluten-free diet improves blood flow to the brain and can eliminate or significantly reduce headache and migraine.
- Irritability - Irritability (crankiness, excessive anger or frustration) can be caused by gluten ingestion in people with celiac disease. Sometimes it is the only symptom in young children.
- Seizure - Seizure disorder (i.e. epilepsy, abnormal electrical activity in the brain; causing drooling, grunting, loss of bladder/bowel control, shaking, falling, teeth clenching, mood changes, halt in breathing, muscle spasms, blackout, confusion, eye movement, etc.) is more common in children with celiac disease.
- None of the above
Gastrointestinal Conditions*
Please select all that apply.
- Abdominal pain - Abdominal pain (ache in the stomach area) after gluten ingestion is reported by people with celiac disease after gluten ingestion.
- Acid reflux (heartburn) - Acid reflux (burning feeling in the chest, throwing up small amounts of vomit to the mouth) is reported by people with celiac disease after gluten ingestion.
- Bloating - Bloating (feelings of a full or tight abdomen, swelling of the abdomen) is reported by people with celiac disease after gluten ingestion.
- Constipation - Constipation (bowel movements are difficult to pass or become rarer) is reported by people with celiac disease after gluten ingestion.
- Diarrhea - Diarrhea (passing loose or watery stools two or more times a day) is reported by people with celiac disease after gluten ingestion.
- Gas - Gas (pain/discomfort in the stomach or intestines from too much gas) is reported by people with celiac disease after gluten ingestion.
- Lactose intolerance - Lactose intolerance (Inability to digest lactose, a sugar found in milk and to a lesser extent milk-derived dairy products) is common in people with celiac disease due to intestinal damage caused by gluten ingestion. This is usually resolved by following a strict, gluten-free diet, which allows the intestines to heal.
- Lymphoma or intestinal cancer - People with celiac disease have an increased risk for lymphoma and intestinal cancers (cancer of white blood cells or cancer in the intestines.) However, there is some evidence that a strict, gluten-free diet can mitigate this risk.
- Pale, foul-smelling stool - Pale, foul-smelling stool (unusually smelly stools with unusual pale color) is reported by people with celiac disease after gluten ingestion.
- Unexplained liver problem - A number of liver diseases are associated with celiac disease. These are autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis and non-alcoholic fatty liver disease (NAFLD).
- Vomiting - Vomiting (throwing up stomach contents) is reported by people with celiac disease after gluten ingestion.
- Weight loss or weight gain - Weight loss and weight gain are both reported by people with celiac disease prior to diagnosis.
- None of the above
Muscular Skeletal Conditions*
Please select all that apply.
- Arthritis - Arthritis (inflammation of joints, joint pain, tenderness, difficulty moving the joint) is one of the common conditions associated with celiac disease.
- Bone or joint pain - Bone or joint achiness or pain is one of the common symptoms associated with celiac disease.
- Fibromyalgia or muscle pain - Fibromyalgia or muscle pain (chronic and widespread pain over the body, tiredness, sleep disturbance, and excessive pain in response to pressure) is commonly reported by people with celiac disease.
- Numbness or pain in hands and feet (peripheral neuropathy) - Peripheral neuropathy (weakness, tingling or burning pain, or loss of feeling in the hands or feet) is commonly reported by people with celiac disease.
- Osteopenia or osteoporosis - Osteopenia and osteoporosis (low bone mineral density, weak bones) are associated with celiac disease because of the body's inability to absorb calcium and vitamin D due to intestinal damage caused by long-term gluten consumption.
- Short stature - Adults with celiac disease are often shorter than would be expected due to a delay in adhering to a strict, gluten-free diet.
- None of the above
Reproductive Conditions*
Please select all that apply.
- Delayed puberty - Delayed puberty (no breast development in girls by 13, no testicular enlargement in boys by 14) may result from undiagnosed celiac disease because of the body's inability to absorb nutrients due to intestinal damage caused by long-term gluten consumption.
- Infertility - Infertility (inability to get pregnant after having unprotected, regular sex from six months to a year) is reported to be associated with celiac disease.
- Menstrual irregularities - Menstrual irregularities and missed periods (periods do not occur regularly or occur infrequently with no/small amounts of bleeding, or excessive bleeding, or periods that occur regularly but with excessive bleeding) are reported to be associated with celiac disease.
- Miscarriage - Miscarriage (loss of a fetus in pregnancy before the 20th week) is reported to be associated with celiac disease.
- None of the above
Skin and Dental Conditions*
Please select all that apply.
- Discolored teeth or enamel loss - Discolored teeth and enamel loss (white, brown or yellow spots on teeth, pitting or banding of teeth, and mottled or translucent-looking teeth) are common in people with celiac disease.
- Eczema - Eczema (inflammation of the skin, redness, skin swelling, itching, dryness, crusting, flaking, blistering, cracking, oozing, or bleeding) is common in people with celiac disease.
- Itchy skin rash (dermatitis herpetiformis) - Dermatitis Herpetiformis (Itchy blisters on the skin filled with a watery fluid) is a skin manifestation of celiac disease, occuring in 15 to 25 percent of people with celiac disease. It is commonly diagnosed as eczema, and usually resolves on a strict, gluten-free diet.
- Loss of hair from your head or body (alopecia) - Alopecia areata (hair loss, especially on the scalp) is common in people with celiac disease.
- Recurrent mouth canker sores/oral ulcers (aphthous stomatitis) - Recurrent mouth canker sores/oral ulcers (sores on the inner side of the lips and cheeks) are a common condition of celiac disease.
- None of the above
Other Conditions and Autoimmune Disorders*
Diagnosed Conditions - Please select all that apply.
- Autoimmune hepatitis - Autoimmune hepatitis occurs when the body’s immune system attacks the liver, causing damage. It is common for autoimmune conditions to co-exist; approximately 6% of autoimmune hepatitis patients also have celiac disease. There is some indication that a gluten-free diet can reverse the liver damage in these patients, though a gluten-free diet has yet to be shown to be effective with autoimmune hepatitis generally.
- Addison's disease - Addison’s disease is a disorder of the adrenal glands, causing them to produce insufficient amounts of cortisol and aldosterone. Addison’s Disease occurs across all age groups and both sexes and can be life threatening; between 5-12% of individuals with Addison’s Disease also have celiac disease, and vice versa. Treatment generally consists of hormone replacement therapy to compensate for adrenal insufficiency.
- Crohn's disease; inflammatory bowel disease - Crohn’s disease and celiac disease share many common symptoms, though the underlying causes are different. In Crohn’s disease, the immune system could be causing disruption anywhere along the gastrointestinal tract, and more diagnostic testing is needed than to establish a celiac diagnosis. Treatment consists of changes to diet and possible surgery. A substantial overlap (up to 10%) of patients with these two conditions suggests there may be a genetic connection between the two, and research is continuing in that area.
- Chronic pancreatitis - Chronic pancreatitis is an inflammation of the pancreas that worsens over time, ultimately leading to an inability to digest food and to produce pancreatic hormones. Celiac patients have long been known to be at increased risk for pancreatitis, a risk up to three times greater than in the general population.
- Down syndrome - Between 5-16% of people with Down Syndrome also have celiac disease; all individuals with DS should be tested for celiac between ages 2 and 3. Down Syndrome, also known as Trisomy-21, is a congenital disorder arising from a chromosomal defect. It has many hallmark physical characteristics, including broad facial features, short stature, and disorders of the gastrointestinal system.
- Idiopathic dilated cardiomyopathy - Dilated cardiomyopathy is a condition in which the chambers of the heart have become enlarged, or dilated, causing thinning of the muscle and difficulty pumping blood. This can lead to a variety of serious conditions, including heart failure, heart valve problems, arrhythmias and blood clots. A nationwide study published through the American Heart Association found a moderate but not statistically significant prevalence of dilated cardiomyopathy in patients with biopsy-confirmed celiac disease.
- IgA nephropathy (Berger's disease) - IgA nephropathy occurs when the antibody immunoglobulin A lodges in the kidneys, impeding their ability to filter wastes from the blood. The exact causes of IgAN are not known, though genetic factors, infections, and celiac disease are all possible sources of predisposition – approximately 2-3% of patients with celiac disease also have IgAN.
- Irritable bowel syndrome (IBS) - IBS is a disruption of the gastrointestinal system, specifically the colon, that can cause a constellation of symptoms including diarrhea, constipation or both. It is quite widespread, affecting about 10-15% of the worldwide population. As many as 10% of those diagnosed with IBS may actually have celiac disease instead of, or in addition to, IBS.
- Juvenile idiopathic arthritis - Arthritis is the informal name used to identify over 100 diseases of the joints; common symptoms are pain, inflammation and stiffness. Some types of arthritis are autoimmune, like celiac disease, and may respond to treatment with a gluten-free diet, though a strong correlation between the two conditions has yet to be established.
- Multiple sclerosis - Multiple sclerosis is a chronic, long-term, degenerative disease in which the immune system destroys myelin, the protective sheath that covers nerve cells. Because of its involvement with the central nervous system, this devastating disease can affect all manner of functions, including vision, speech, cognition and motor skills. There is an increased chance of co-occurrence of MS and celiac disease, and it is recommended that patients with either condition be routinely tested for the other.
- Non-Alcoholic fatty liver disease - Nonalcoholic fatty liver disease is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. The main characteristic of nonalcoholic fatty liver disease is too much fat stored in liver cells.
- Primary biliary cirrhosis - PBC is a rare autoimmune disease in which the bile ducts are slowly destroyed. This can cause buildup of harmful substances in the liver, leading to scar tissue (cirrhosis) and liver failure. There is a strong association between PBC and celiac disease; reciprocal screening is crucial.
- Primary sclerosing cholangitis - PSC presents similarly to PBC, but is a result of different antibody production affecting the bile ducts. This condition is more commonly associated with ulcerative colitis, and is more prevalent in men, while PBC is more prevalent in women. While there is some discrepancy in the literature regarding the overall comorbidity of PSC and celiac disease, routine celiac screening is recommended for patients with cholestatic liver diseases, as early adoption of the gluten-free diet can limit additional complications for these patients.
- Psoriasis - Psoriasis is a skin condition identified by rough, red, scaly patches, and is believed to be an immune condition. As such, it is certain that there is some correlation between celiac disease and psoriasis, though the rate of comorbidity is currently unknown. Though in many case psoriasis symptoms may be relieved through treatment with a gluten-free diet, this does not necessarily mean that celiac disease is present.
- Rheumatoid arthritis - RA is a systemic, autoimmune type of arthritis that causes inflammation, specifically in the joints of the hands, feet, knees, wrists, elbows and ankles. Unchecked, it can cause irreversible damage and deformation of the joints. While there is no documented correlation between RA and celiac disease, the development of effective drug treatments for RA has given researchers hope that similar drugs may be able to be developed for other autoimmune conditions, like celiac disease.
- Scleroderma - Another autoimmune condition, scleroderma, causes a hardening and tightening of the skin and connective tissue. It is chronic and without cure, and though it is likely genetically linked, it does not seem to be hereditary. Celiac disease is a known trigger for scleroderma, and celiac patients should be routinely monitored for development of skin and rheumatoid symptoms.
- Sjogren's disease - Sjogren’s syndrome is an autoimmune condition which manifests as dryness of the lachrymal and salivary glands, causing dry eyes and dry mouth. The rate of celiac disease in Sjogren’s patients may be as high as 15%, and may often present as silent (asymptomatic) celiac. Individuals with Sjogren’s syndrome may wish to consider screening for celiac disease, as adherence to a gluten-free diet may help alleviate symptoms when both conditions are present.
- Thyroid disease - A decrease in the thyroid gland’s hormone production leads to a condition called hypothyroidism; the most common cause for this is an autoimmune condition called Hashimoto’s Thyroiditis, in which the immune system attacks and damages the thyroid gland. This condition is most common in middle-aged women but can occur across all ages and both sexes; about 3.5% of patients with Hashimoto’s also have celiac disease.
- Turner syndrome - Turner syndrome is a chromosomal abnormality in which females are born with only a single X chromosome. Affected individuals experience a variety of physical and reproductive consequences of the condition, including short stature, delayed or absent puberty, and infertility. A large percentage (33-50%) of affected women also experience significant, even life-threatening, heart defects. Prevalence of celiac disease is estimated at about 4-8% of the Turner Syndrome population, compared to 1-2% in the general populace, and routine screening after age 3 is recommended.
- Type 1 diabetes - Type 1 diabetes, formerly known as Juvenile Diabetes, is an autoimmune condition in which the body attacks the insulin-producing cells of the pancreas, preventing the body’s cells from absorbing and using glucose. Treatment for this condition is the external provision of insulin, usually through daily injections. The relationship between type 1 diabetes and celiac is well-established, with approximately 6% overlap between the patient populations. Reciprocal testing is recommended, though it is common for T1D to be diagnosed first.
- Ulcerative colitis; inflammatory bowel disease - Ulcerative colitis causes inflammation and ulceration throughout the large intestine, resulting in pain and gastrointestinal distress. Unlike Crohn’s disease, which can affect any part of the GI tract at any tissue depth, ulcerative colitis is limited to the lining of the colon. While both ulcerative colitis/IBD and celiac disease both cause affect the gut and cause gastrointestinal symptomology, correlation between the two diseases is no stronger than with other autoimmune conditions.
- Williams syndrome - Williams syndrome is a genetic condition affecting an estimated 1 in 10,000 people worldwide. It is identified by characteristic facial features, a cheerful and endearing personality, learning and developmental delays and a variety of cardiovascular and musculoskeletal issues. An estimated 8% of those with Williams Syndrome develop celiac disease; routine screening is recommended beginning at age 3.
- None of the above
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Symptoms & Conditions*
- Yes
- No
Thank you for completing the Symptoms Assessment Tool.

Your responses indicate that you are not at an increased risk for celiac disease*.

Screening is not recommended at this time. However, since there are more than 200 known symptoms associated with celiac disease, it is important to discuss with your physician any unexplained symptoms you may have.

If you still have concerns about your risk of celiac disease, or would like to get involved with the Celiac Disease Foundation, please email us at [email protected] or call us at 818.716.1513, x104

* Based on the evidence based guideline: “Coeliac disease: recognition, assessment and management” NICE guideline NG20, Sept 2015.
Thank you for completing the Symptoms Assessment Tool

Your responses indicate that you may be at an increased risk for celiac disease.

We recommend that you make an appointment with your physician to discuss screening for celiac disease. The first step is a simple blood test. If you would like to receive a letter for your physician, please provide us with some basic information below.

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It is critical that you be eating gluten until you have completed testing. If you are not eating gluten the results may not be accurate. If you are unable or unwilling to eat gluten, talk to your doctor about genetic screening for celiac disease.

If you have questions or would like to get involved with the Celiac Disease Foundation, please email us at [email protected] or call us at 818.716.1513, x104.
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* Based on the evidence based guideline: “Coeliac disease: recognition, assessment and management” NICE guideline NG20, Sept 2015.

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