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Celiac Disease

Non-Classic Symptoms of Celiac Disease on the Rise

There are more indicators for celiac disease than just the typical “textbook” symptoms, according to a much-cited Italian study, published in November 2014.

The symptoms most commonly related with celiac disease are diarrhea and weight loss, but research published in the medical journal BMC Gastroenterology confirms what gastroenterologists have been saying anecdotally: that there are now a diverse range of signs of the autoimmune disorder.

Researchers examined trends among the 770 patients diagnosed with celiac disease at St. Orsola-Malpighi University Hospital in Bologna, Italy from January 1998 to December 2012.  There was a significant increase in the number of cases of celiac diagnosis during the study, and researchers found a majority of the patients diagnosed had what had been considered “atypical” symptoms. These included non-gastrointestinal conditions such as anemia, the skin rash dermatitis herpetiformis, osteoporosis, and Hashimoto’s disease (a thyroid disorder).

Diarrhea, considered a classic symptom, was only seen in 27 percent of patients, but there were also non-classical gastrointestinal symptoms such as constipation, alternating bowel disorders, reflux and vomiting.

Dr. Umberto Volta, one of the study’s co-authors, said that the most striking result of the study was the indication that leading indicators of the disease are changing.

Other notable findings include:

  • Most patients were diagnosed between the age of 30 and 40.
  • Nearly 8 out of 10 patients showed some kind of symptom of celiac disease.
  • Celiac disease was more frequently diagnosed in women than men by a ratio of 3.5 to 1.
  • Over the course of the study, classic symptoms became less common, dropping from 47% during the first decade of research to 13% of the cases in the final five years of the study.

“A high proportion of celiac disease patients did not show any gastrointestinal symptom, but they displayed extra-intestinal manifestations such as iron-deficiency anemia, unexplained osteoporosis, abnormalities of liver-function tests and recurrent miscarriages,” Volta told Reuters. As well, two out of 10 diagnosed patients showed no detectable signs of the disease.

Given the range of symptoms, experts advise those with persistent symptoms to consult a doctor and get tested, rather than simply trying out a gluten-free diet.

“Right now, we are testing a lot more patients than we have in the past.” Mayo Clinic celiac expert Dr. Joseph Murray said in a Q&A with Allergic Living. “If I see a patient with anemia, I say, ‘Be tested.’ I say the same for those who have diarrhea or for all family members of patients who have already been diagnosed.”

Nearly 1 percent of the global population is living with celiac disease – and these rates are on the rise. But Volta and his team note that this condition often goes undiagnosed, “leaving the celiac ‘iceberg’ still submerged.”

It is estimated that majority of Americans who have celiac disease do not know or are misdiagnosed with other conditions, according to the National Foundation for Celiac Awareness.

“We still miss about 80 percent of people who have the condition and, frankly, we don’t know what the impact of that is,” said Murray, author of Mayo Clinic Going Gluten-Free: The Essential Guide to Managing Celiac Disease and Other Related Conditions. “Ultimately, to find every person with celiac disease, we need to screen everyone at risk. Does that mean we need to test everyone? I’m not sure – but we do need to test a lot more people than we already are.”

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