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Non-classical Symptoms Common for Vast Majority with Celiac Disease 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.

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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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14 Responses:

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said this on
28 Dec 2014 11:00:14 AM PST
It's a lot to think about.

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said this on
29 Dec 2014 6:30:34 AM PST
I found this article to lift the roof off of my personal experience. The definitions of technical/medical language were quite helpful. Still yet, there were moments when the reading level left me feeling as if I was reading from a medical journal.

Sue Parks
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said this on
29 Dec 2014 8:16:42 AM PST
Thank you for all of your excellent articles. I love the data you use to prove/disprove theories about celiac. In my case, I was 50 before I was diagnosed-never had diarrhea and, sadly, my doctor of many years felt that was the must needed symptom to diagnose. By the time I was diagnosed, I had a complete stricture, terrible ulcers, skin lesions and full blown lupus and sjogrens. And what did I do when my stomach was a mess-eat a bowl of cereal as I was told to eat a bland diet. Unfortunately, I found bread alone can kill you slowly and painfully. I lived a life of silent suffering always thinking it was in my head until I finally put my food down when I could not even swallow water. We have to bring light to this terrible disease and malfunction. Thank you for doing so!

Rick M.
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said this on
29 Dec 2014 8:26:22 AM PST
Was I missing something or was vomiting not listed as a "non-classical" symptom?

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said this on
29 Dec 2014 5:03:06 PM PST
Excellent point! I ended up with this happening as I got to the point of barely being able to eat anymore... I think they didn't consider what happens when an un-diagnosed person gets near the point of an emergency room visit...
What about the smell of gluten products when in a severe reactive state? Anyone have that?

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said this on
29 Dec 2014 12:47:07 PM PST
It's highly informative to know that the celiac patients could show no symptoms.

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said this on
29 Dec 2014 1:56:10 PM PST
Once again Jefferson, you come through with an interesting and concise article. Thanks so much for your continuing research.

Gloria Clemons
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said this on
29 Dec 2014 2:52:19 PM PST
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.

R Hyde
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said this on
12 Jan 2015 4:19:54 AM PST
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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said this on
29 Dec 2014 2:56:36 PM PST
Very interesting indeed.

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said this on
29 Dec 2014 9:41:14 PM PST
Nine months ago after I connected the dots (and being told 5 years ago after a colonoscopy that I did not have celiac disease) I had genetic testing. It found that I had a gluten sensitivity gene from one parent and a gluten sensitivity/celiac gene from the other parent. The dots I connected were that I had a blistery rash on and off for 26 years and finally connected it to every time I ate wheat. My grandmother died of non-alcoholic cirrhosis of the liver and my brother was diagnosed at 16 with type 1 diabetes (52 years ago). After I was diagnosed my brother asked his endocrinologist about celiac and was told he was too old and he didn't have the symptoms... vomiting, etc. The doctor did not even suggest at least having a blood test.

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said this on
31 Dec 2014 4:42:36 PM PST
Tell your brother to RUN to a new doctor.


said this on
02 Jan 2015 1:17:42 AM PST
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

Miguel Rosado
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said this on
05 Jan 2015 4:13:21 PM PST
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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