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  • Jefferson Adams
    Jefferson Adams

    Non-classical Symptoms Common for Vast Majority with Celiac Disease

    Reviewed and edited by a celiac disease expert.

    Caption: Photo: CC--liviana1992

    Celiac.com 12/26/2014 - Celiac disease can have such a wide-ranging number of symptoms, ranging over so many parts of the body, that it can be hard for doctors seeking to make a diagnosis to even suspect celiac disease as an underlying cause in the first place.

    Photo: CC--liviana1992A team of researchers set out to better understand the characteristics of celiac disease by looking at the findings in a large number of celiacs diagnosed in a single referral center, and to using clear definitions of the clinical, serological and histopathological aspects of celiac disease to get a better picture of how the disease presents itself.

    The research team included Umberto Volta, Giacomo Caio, Vincenzo Stanghellini and Roberto De Giorgio of the Department of Medical and Surgical Sciences at the University of Bologna’s S. Orsola-Malpighi Hospital, in Bologna, Italy.

    For their study, their team looked at data on celiac patients admitted to S. Orsola-Malpighi Hospital from January 1998 to December 2012. They found a total of 770 patients ranging from 18 to 78 years, averaging 36 years old. A total of 599 patients were female.

    The team broke celiac disease down into three types: The first type, classical, in which patients present with malabsorption syndrome. The second type, non-classical, in which patients experience extraintestinal and/or gastrointestinal symptoms other than diarrhea. The third type, subclinical, with no visible symptoms.

    The team evaluated patient serology, duodenal histology, comorbidities, response to gluten-free diet and complications.

    A total of 610 patients (79%) showed clear physical symptoms when they were diagnosed, while 160 celiacs showed a subclinical phenotype.

    In the symptomatic group 66% of celiacs were non-classical, that is, they experienced extraintestinal and/or gastrointestinal symptoms other than diarrhea.

    Only 34% of patients in the symptomatic group showed classical malabsorption syndrome.

    The team found that just 27% of the non-classically symptomatic group complained of diarrhea, while other gastrointestinal manifestations included bloating (20%), aphthous stomatitis (18%), alternating bowel habit (15%), constipation (13%) and gastroesophageal reflux disease (12%). Extraintestinal manifestations included osteopenia/osteoporosis (52%), anemia (34%), cryptogenic hypertransaminasemia (29%) and recurrent miscarriages (12%).

    Positivity for IgA tissue transglutaminase antibodies was detected in 97%. Th steam found villous atrophy in 87%, while 13% had minor lesions consistent with potential celiac disease.

    A large proportion of patients showed autoimmune disorders, such as autoimmune thyroiditis (26.3%), dermatitis herpetiformis (4%) and diabetes mellitus type 1 (3%). Complicated celiac disease was very rare.

    This study demonstrates that the clinical profile of celiac disease has changed over time, and now features much more non-classical and subclinical phenotypes.


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    Brilliant article - I have never been diagnosed as 'coeliac' but have suffered a massively curtailed life with chronic illness. Being repeatedly dismissed by doctors telling me I wasn't coeliac because I don't have classic villi destruction. However, I echo so much of what every ne else is saying. In the end I was so desperate, unable to walk and in pain I went on a gluten free diet and had an instant health improvement. Unfortunately having never been treated and suffering obvious symptoms for 40 years my health was badly damaged and will never be fully well again. I do have a consultant now who understands my non coeliac gluten sensitivity.


    Maxine - yes I do 'smell' gluten if I open a cupboard with any gluten containing food in it. I am very ill indeed if I accidentally ingest any. I was almost am accident and emergency admission in an ambulance at one point.


    This is a serious health issue and most doctors just don't believe it or get how ill people are with it

    I am not crazy! I am not the only one claiming a to have gluten reaction from smelling gluten! so, there is something to it.... I have the same gene problem than Maggielynne could be the same for you John.

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    I was told 2 years ago that I had celiac disease after a colonoscopy. I had no outward symptoms so I did nothing about it. I did have a very low B12 count and the doctor was unable to control my iron levels so he ordered another colonoscopy and again I was told I had celiac disease. I also peripheral nuropathy. So I decided to do the gluten free diet about 3 months ago. I can't see any change yet but I have lost about 7 lbs. I have not had any trouble giving up bread since I didn't eat that much anyway. But I do miss pizza. I am doing this in hopes that it will help the neuropathy somehow. So far no change. I also have spinal stenosis. My doctor had never taken celiac seriously.

    I had the neuropathy too and found it was caused directly by Vitamin B12 deficiency. It got a lot better after I took 1000 mcg of B12 sublingually (sublingual lozenges provide direct absorption through oral tissues, not going through the impaired digestive system) for several months.


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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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