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Coeliac disease: symptoms

Coeliac disease can manifest at any age and present with a variety of symptoms that can affect both the gastrointestinal tract and other organ systems. Typical gastrointestinal symptoms include diarrhoea, flatulence, abdominal pain and weight loss. However, extraintestinal symptoms such as iron deficiency, fatigue, skin changes and neurological abnormalities are also possible. One characteristic of gluten intolerance is that it can also be completely asymptomatic, especially in adults or older people. An important aspect of coeliac disease diagnosis : There is no clinical presentation that can rule out coeliac disease with certainty. Even in the case of symptoms such as obesity or chronic constipation, which are not classically associated with the disease, coeliac disease should be considered – especially if there is a family history or accompanying autoimmune diseases.


Clinical picture of coeliac disease (in drop-down menu)

FormClinicalCoeliac disease AntibodiesGenetics HLAHistology
ClassicSigns of malabsorptionPositiveDQ2 / DQ8Marsh 2 or 3
SymptomaticNon-specific gastrointestinal or extraintestinal symptomsPositiveDQ2 DQ2 /Marsh 2 or 3
SubclinicalNo clinical symptoms, but abnormal laboratory values or clinical improvement on dietPositiveDQ8/ DQ8Marsh 2 or 3
PotentialNo or few specific symptomsPositiveDQ8/ DQ8Marsh 0 or 1
RefractorySigns of malabsorption and villous atrophy despite a gluten-free diet for over 12 monthsPositive at initial diagnosis, course negative or positiveDQ8/ DQ8Marsh 3

Table: Forms of coeliac disease (Oslo classification) according to S2k guideline

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Sources

  • Felber, J., Bläker, H., Fischbach, W., Koletzko, S., Laaß, M.W., Lachmann, N., Lorenz, P., Lynen, P., Reese, I., Scherf, K., Schuppan, D. & Schumann, M. (2021). Updated S2k guideline on coeliac disease from the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS). Consultation version October 2021
  • Verdelho Machado M. Refractory Celiac Disease: What the Gastroenterologist Should Know. Int J Mol Sci. 2024 Sep 26;25(19):10383. doi: 10.3390/ijms251910383. PMID: 39408713; PMCID: PMC11477276.