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Celiac disease: Symptoms

Celiac 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 diarrhea, bloating, abdominal pain, and weight loss. However, extraintestinal symptoms such as iron deficiency, fatigue, skin changes, and neurological abnormalities are also possible. A notable feature of gluten intolerance is that it may present without any symptoms, especially in adults or older people. An important consideration in diagnosing celiac disease is that There is no clinical presentation that can rule out celiac disease with certainty. Even in the presence of symptoms such as obesity or chronic constipation, which are not classically associated with the disease, celiac disease should be considered-especially if there is a family history or accompanying autoimmune diseases.


Clinical picture of celiac disease

FormClinicalCeliac 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 noticeable 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 of the disease negative or positiveDQ8/ DQ8Marsh 3

Table: Forms of celiac 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 celiac 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.