As far back as the second century, a Greek physician named Aretaeus of Cappadocia wrote detailed descriptions of celiac disease and its symptoms in children and adults, including diarrhea with fatty stools, gassiness, wasting, weakness, and pallor. Aretaeus called his patients by the Greek word koiliakos, which meant "suffering in the bowels." In the first translation of Aretaeus’s writings from Greek to English by Francis Adams in 1856, koiliakos became "celiacs."
In the classic form of celiac disease, patients have severe chronic diarrhea with voluminous stools that float in the water, and weight loss to the point of wasting. This form is very common in infants and young children with celiac disease, who tend to develop bowel symptoms and growth problems shortly after they begin to eat gluten-containing cereals. In fact, it was once thought (incorrectly) that celiac disease occurred only in children, and that in most cases the children could outgrow it.
Today, we know that celiac disease can begin at any age, persists for life, can involve multiple organs, and that in both children and adults the symptoms of the disease can be extremely variable – or there may be no obvious symptoms at all. Because there is no standard “picture” of a person with celiac disease, some patients go from doctor to doctor for years, seeking a diagnosis for their illness.
The symptoms of celiac disease almost always disappear when the patient follows a strict gluten-free diet. In rare circumstances, when the intestines are so severely damaged by chronic inflammation that they cannot heal even with the gluten-free diet, the patient is said to have unresponsive, or refractory, celiac disease.
Gastrointestinal-Related Symptoms of Celiac Disease
These symptoms may be mistakenly attributed to other gastrointestinal problems, such as stomach ulcers, Crohn's disease, or inflammatory bowel disease:
- Diarrhea
- Constipation
- Chronic indigestion
- Chronic bloating
- Poor appetite
- Abdominal cramping, pain, and distention.
- Mouth ulcers
- Lactose intolerance
In addition, long-standing untreated celiac disease leads to an increased risk of adenocarcinoma and lymphoma of the small intestine. Even with this increased risk, however, the incidence of these cancers in celiac patients is very rare, and when patients follow a strict gluten-free diet, their risk reportedly drops down to equal the risk of any other healthy person.
Malabsorption-Related Symptoms of Celiac Disease
The flattening of the villi and other changes in the small intestine impair its ability to absorb nutrients, minerals and fat-soluble vitamins (A, D, E, and K). Signs and symptoms of malabsorption include:
- Weight loss
- Failure to thrive/stunted growth in children
- Fatigue
- Anemia
- Osteopenia or osteoporosis
- Abnormal coagulation due to deficiency of vitamin K
- Bacterial overgrowth of the small intestine
Other Symptoms of Celiac Disease
- Dermatitis herpetiformis (a specific type of extremely itchy rash)
- Unexplained short stature
- Delayed puberty
- Infertility
- Recurrent miscarriage
- Dental enamel abnormalities
- Autoimmune endocrine disorders, including thyroid disease
- Depression and anxiety
- Peripheral neuropathy
- Ataxia
- Epilepsy
- Subtle abnormalities in blood tests for no obvious reason (also referred to as "unexplained abnormal serum chemistries")
- Elevated liver function tests
- Low serum (blood) protein levels
- Low serum (blood) calcium levels
What Do These Lists of Symptoms Mean?
These varied lists of symptoms reinforce the fact that there’s no “typical” way for celiac disease to be recognized. It's easy to miss, unless doctors and patients remember to consider it. This is especially true for people with multiple medical or quality-of-life problems and in individuals who are completely fine but who have a genetic predisposition. If celiac disease is discovered, adoption of a gluten-free diet will reduce the risks for serious long-term complications.
Sources:
Aretaeus. The Extant Works of Aretaeus, The Cappadocian. Translated and Edited by Francis Adams for the London Sydenham Society, 1856. Retrieved on 11 October 2007 from
Digital Hippocrates.
National Institutes of Health Consensus Development Conference on Celiac Disease.
