Celiac Disease Symptoms

How do symptoms of celiac disease differ with age of onset? continued...

Adults with celiac disease may have symptoms of diarrhea, steatorrhea, weight loss and flatulence; however, many adults do not have diarrhea or steatorrhea. They have either no symptoms or only vague abdominal discomfort such as bloating, abdominal distension and excess gas. They also may have only one, or only a few signs of malnutrition such as iron deficiency anemia, abnormal bleeding, or bone fractures. Some patients with celiac disease and gastrointestinal symptoms are mistakenly diagnosed with irritable bowel syndrome. For more information, please see the Irritable Bowel Syndrome article.

There have been changes during the past 20 years in the way in which celiac disease is diagnosed. The average age at which celiac disease is diagnosed has increased, probably because of the increased awareness that the disease can first cause symptoms or signs in adults. Whereas diarrhea was the initial symptom in 80% of patients, it now is the initial symptom in only 40%. A small proportion of patients-about 15%--are now diagnosed with blood antibody tests because they have a close relative with celiac disease and they are being screened to see if they also have the disease.

What are latent and silent celiac disease?

The terms latent and silent celiac disease are used to refer to patients who have inherited the genes that predispose them to celiac disease but have not yet developed the symptoms or signs of celiac disease.

Latent celiac disease refers specifically to patients who have abnormal antibody blood tests for celiac disease (see discussion of specific tests for celiac disease) but who have normal small intestines and no signs or symptoms of celiac disease. For example:

• Some patients may have had a childhood onset of celiac disease and the disease may have been successfully treated with a gluten-free diet. The patients' intestines may have resumed a normal appearance and function, and they may have no signs or symptoms of celiac disease.
• Some patients with celiac disease in childhood abandon the gluten free diet as adults, yet they remain free of the signs or symptoms of celiac disease.

In both of the above instances, the celiac disease is latent, and the patients can develop signs and symptoms of celiac disease later in life.

Silent celiac disease refers to patients who have abnormal antibody blood tests for celiac disease as well as loss of villi in the small intestine but have no symptoms or signs of celiac disease, even on a normal diet that contains gluten. Like patients with latent celiac disease, these patients can develop signs or symptoms of celiac disease later in life.

What diseases are associated with celiac disease?

The following are diseases associated with celiac disease:

• An estimated 10% of patients with celiac disease also have dermatitis herpetiformis. Dermatitis herpetiformis is a disease of the skin that is characterized by an itchy rash on the extremities, buttocks, neck, trunk, and scalp.
• Recurrent, painful mouth ulcers (aphthous stomatitis)
• Insulin-dependent diabetes (juvenile-onset or type 1 diabetes)
• Autoimmune thyroid disease
• Rheumatoid arthritis
• Systemic lupus