What are the symptoms of celiac disease?

Symptoms of celiac disease can vary from person to person. They usually occur in the digestive system but can also affect other parts of the body. Digestive symptoms are more common in infants and young children and may include:

• abdominal bloating and pain
• weight loss
• chronic diarrhea
• constipation
• vomiting
• pale, foul-smelling, or fatty stool

Why are celiac disease symptoms so varied?

Researchers are studying why celiac disease affects people differently. The age a person starts eating foods containing gluten and the amount of these foods being eaten are two factors that may play a role in when and how celiac disease appears. Other studies have shown that the longer a person was breastfed, the later the symptoms of celiac disease appear.

Symptoms also vary depending on a person’s age and the degree of damage to the small intestine. Many adults can have the disease for a decade or more before they are diagnosed. The longer a person goes undiagnosed and untreated, the greater the chance of developing long-term complications.

What other health problems do people with celiac disease have?

Celiac disease sufferers tend to have other diseases in which the immune system attacks the body’s healthy cells and tissues. The connection between celiac disease and these other diseases may be genetic. They include

• type 1 diabetes
• autoimmune liver disease
• autoimmune thyroid disease
• Addison’s disease, a condition in which the glands that produce critical hormones are damaged
• rheumatoid arthritis
• Sjögren’s syndrome, a condition in which the glands that produce tears and saliva are destroyed

How is celiac disease diagnosed?

Celiac disease can be difficult to diagnose because some of its symptoms are similar to other diseases. Celiac disease can be confused with irritable bowel syndrome, intestinal infections, iron-deficiency anemia caused by menstrual blood loss, diverticulitis, inflammatory bowel disease, and chronic fatigue syndrome. As a result, celiac disease can be often misdiagnosed. Diagnosis rates have been increasing as doctors become more aware of the varied symptoms of the disease and reliable blood tests become more available.

People with celiac disease have higher than normal levels of certain autoantibodies – proteins that react against the body’s own cells or tissues – in their blood. To diagnose celiac disease, doctors will test blood for high levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). If test results are negative but celiac disease is still suspected, additional blood tests may be needed.

Before being tested, one should continue to eat a diet that includes foods with gluten, such as breads and pastas. If a person stops eating foods with gluten before being tested, the results may be negative for celiac disease even if the disease is present.

If blood tests and symptoms suggest celiac disease, a biopsy of the small intestine is performed to confirm the diagnosis. During the biopsy, the doctor removes tiny pieces of tissue from the small intestine to check for damage to the villi. To obtain the tissue sample, the doctor eases a long, thin tube called an endoscope through the patient’s mouth and stomach into the small intestine. The doctor then takes the samples using instruments passed through the endoscope.

Dermatitis herpetiformis (DH) is an intensely itchy, blistering skin rash that affects 15 to 25 percent of people with celiac disease. The rash usually occurs on the elbows, knees, and buttocks. Most people with DH have no digestive symptoms of celiac disease.

DH is diagnosed through blood tests and a skin biopsy. If the antibody tests are positive and the skin biopsy has the typical findings of DH, patients do not need to have an intestinal biopsy. Both the skin disease and the intestinal disease respond to a gluten-free diet and recur if gluten is added back into the diet. The rash symptoms can be controlled with antibiotics such as dapsone. Because dapsone does not treat the intestinal condition, people with DH must maintain a gluten-free diet.

Screening for celiac disease means testing for the presence of autoantibodies in the blood in people without symptoms. Americans are not routinely screened for celiac disease. However, because celiac disease is hereditary, family members of a person with the disease may wish to be tested. Four to 12 percent of an affected person’s first-degree relatives will also have the disease.