Celiac disease can be difficult to diagnose because it affects people differently. There are more than 200 known symptoms which may occur in the digestive system or other parts of the body. Some people develop celiac disease as a child, others as an adult. The reason for this is still unknown.
Some people with celiac disease have no symptoms at all, but still test positive on the celiac disease blood test. A few others may have a negative blood test, but have a positive intestinal biopsy. However, all people with celiac disease are at risk for long-term complications, whether or not they display any symptoms.
Does Your Child Have Celiac Disease?
- abdominal bloating and pain
- chronic diarrhea
- pale, foul-smelling, or fatty stool
- weight loss
- irritability and behavioral issues
- dental enamel defects of the permanent teeth
- delayed growth and puberty
- short stature
- failure to thrive
- Attention Deficit Hyperactivity Disorder (ADHD)
Do You Have Celiac Disease?
Adults are less likely to have digestive symptoms, with only one-third experiencing diarrhea. Adults are more likely to have:
unexplained iron-deficiency anemia
bone or joint pain
osteoporosis or osteopenia (bone loss)
- liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis, etc.)
depression or anxiety
peripheral neuropathy ( tingling, numbness or pain in the hands and feet)
seizures or migraines
missed menstrual periods
infertility or recurrent miscarriage
canker sores inside the mouth
dermatitis herpetiformis (itchy skin rash)
Classical, Non-Classical and Silent Celiac Disease
According to the World Gastroenterology Organization, celiac disease may be divided into two types: classical and non-classical.
In classical celiac disease, patients have signs and symptoms of malabsorption, including diarrhea, steatorrhea (pale, foul-smelling, fatty stools), and weight loss or growth failure in children.
In non-classical celiac disease, patients may have mild gastrointestinal symptoms without clear signs of malabsorption or may have seemingly unrelated symptoms. They may suffer from abdominal distension and pain, and/or other symptoms such as: iron-deficiency anemia, chronic fatigue, chronic migraine, peripheral neuropathy (tingling, numbness or pain in hands or feet), unexplained chronic hypertransaminasemia (elevated liver enzymes), reduced bone mass and bone fractures, and vitamin deficiency (folic acid and B12), late menarche/early menopause and unexplained infertility, dental enamel defects, depression and anxiety, dermatitis herpetiformis (itchy skin rash), etc.
Silent celiac disease is also known as asymptomatic celiac disease. Patients do not complain of any symptoms, but still experience villous atrophy damage to their small intestine. Studies show that even though patients thought they had no symptoms, after going on a strict gluten-free diet they report better health and a reduction in acid relux, abdominal bloating and distention and flatulence. First-degree relatives (parents, siblings, children) , whether or not experiencing symptoms, should always be screened, since there is a 1 in 10 risk of developing celiac disease.
The number of ways celiac disease can affect patients, combined with a lack of training in medical schools and primary care residency programs, contributes to the poor diagnosis rate in the United States. Currently it is estimated that 80% of the celiac disease population remains undiagnosed.
CDF offers a Symptoms Checklist to help you and your physician determine if you should be tested for celiac disease.
Who Should Be Screened for Celiac Disease?
According the the Celiac Disease Center at Columbia University Medical Center, “anyone who suffers from an unexplained, stubborn illness for several months, should consider celiac disease a possible cause and be properly screened for it.”
First-degree relatives (parent, child, sibling) should also be screened since they have a 1 in 10 risk of developing celiac disease compared to the general population risk of 1 in 100.
Non-Celiac Wheat Sensitivity
Some people experience symptoms found in celiac disease, such as “foggy mind”, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet, yet do not test positive for celiac disease. The terms non-celiac gluten sensitivity (NCGS) and non-celiac wheat sensitivity (NCWS) are generally used to refer to this condition, when removing gluten from the diet resolves symptoms.
Finding the Right Doctor
Celiac Disease Foundation can help you find the right doctor to discuss symptoms, diagnose, and treat celiac disease. Our nationwide Healthcare Practitioner Directory lists primary care physicians and specialists,and dietitians and mental health professionals, experienced in celiac disease and non-celiac wheat sensitivity.