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Symptoms and Signs of Celiac Disease

Doctor's Notes on Celiac Disease

Celiac disease (also called gluten-sensitive enteropathy and gluten-induced enteropathy) is a chronic autoimmune disease of the digestive tract that interferes with the digestion and absorption of nutrients from food. People with celiac disease are unable to tolerate gluten, a protein commonly found in wheat, rye, barley, and to some degree, oats. In celiac disease, when an affected person ingests foods containing gluten, the lining of the intestine becomes damaged due to the body's immune reaction.

Symptoms of celiac disease include abdominal pain or discomfort, vomiting, diarrhea, bloating, gas, fatty stools, fatigue, weakness, and in children, behavioral disturbances such as depression, irritability, and poor school performance may occur. Because celiac disease affects the absorption of nutrients essential for growth, children may have impaired growth and short stature. Patients with celiac disease may also have nutrient and vitamin deficiencies of vitamins D and K due to malabsorption.

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 3/11/2019

Celiac Disease Symptoms

Gastrointestinal symptoms in children

Because celiac disease affects the absorption of nutrients essential for growth, children who are affected may have impaired growth and consequently short stature. Other common signs and symptoms include the following:

The onset of symptoms is usually gradual and coincides with the introduction of cereal into the diet. The symptoms usually diminish in adolescence.

Gastrointestinal symptoms in adults

Celiac disease usually affects adults in the third to fourth decade of life but sometimes later. The signs and symptoms of celiac disease are variable and may include the following:

  • Diarrhea
  • Abdominal discomfort
  • Bloating
  • Steatorrhea, or fatty stools (caused by malabsorption of ingested fat)

Malabsorption of ingested fat results in the delivery of excessive dietary fat to the large bowel. The bacteria in the colon feast on the fats and other undigested and unabsorbed nutrients, generating intestinal gas resulting in bloating and flatulence. In addition, other substances are released, causing secretion of fluid into the intestine and hence diarrhea. Fatigue (tiredness) and weakness can result from the loss of electrolytes, such as potassium and magnesium, due to the diarrhea.

Nutrient and vitamin deficiencies

Iron and folic acid are essential for the production of normal red blood cells (erythrocytes). Abnormalities in the absorption of iron or folic acid may result in anemia (low red blood cell count). Vitamin B-12 deficiencies can also contribute to the anemia noticed in affected persons with a mechanism similar to that of iron and folic acid deficiencies.

Vitamin deficiencies may develop when malabsorption is present. Vitamins soluble in fat are commonly malabsorbed. These include vitamins K and D.

  • Vitamin K is essential for the production of clotting proteins. As a result, vitamin K deficiency causes a bleeding tendency among persons with celiac disease.
  • Vitamin D is essential for the absorption of calcium, which is required for appropriate bone growth. As a result, vitamin D deficiency may cause low blood calcium levels (hypocalcemia). This predisposes children with celiac disease to bone disorders such as rickets. Adults with celiac disease have decreased calcium in the bones, which become soft, a condition referred to as osteomalacia, and may develop fractures. Loss of protein and calcium may lead to osteoporosis, in which the bones are porous and brittle.

Nongastrointestinal (extraintestinal) features

Skin disorders can complicate the course of the celiac disease. These conditions include dermatitis herpetiformis, an itchy skin condition characterized by a rash or blisters involving the extremities, the trunk, the buttocks, the scalp, and the neck.

Neurologic (nervous system) symptoms include weakness, problems with balance, and sensory changes (for example, sensation of touch and pain).

Hormonal disorders, such as loss of menstruation (amenorrhea) and infertility in women, and impotence and infertility in men, are very uncommon.

Celiac Disease Causes

Celiac disease results from a combination of immunological responses to an environmental factor (gluten) and genetic factors. People need both a genetic predisposition and the exposure to gluten in order to develop celiac disease.

Immune mechanisms

  • The interaction of gliadin (a specific gluten present in certain grain products) with the lining of the small intestine is critical in the development of celiac disease. When people with celiac disease eat foods containing gluten, gliadin is identified by the immune system as a threat. As a result, the body produces antibodies called antigliadin antibodies. Antigliadin antibodies are directed against gliadin.
  • Two additional antibodies have been identified in the bloodstream of people with celiac disease. In contrast to antigliadin antibodies, these antibodies target the person's own body and are referred to as autoantibodies (antibodies against our own cells and organs). The first antibody targets endomysium, a small intestinal smooth muscle component. The second antibody targets an enzyme called tissue transglutaminase. The presence of these autoantibodies suggests that autoimmunity plays a role in the disease process of celiac disease.
  • Genetic factors: Genes play an important role in celiac disease. Celiac disease occurs much more frequently in relatives of persons with celiac disease than in the general population.

Celiac Disease Symptoms, Gluten in Foods, Gluten Allergy Tests, and More Slideshow

Celiac Disease Symptoms, Gluten in Foods, Gluten Allergy Tests, and More Slideshow

Celiac disease is a digestive disorder that occurs in reaction to gluten, a protein found in rye, barley, wheat, and hundreds of foods made with these grains. The body's immune system reacts to the gluten and causes damage to the intestine. Celiac disease, also known as celiac sprue or gluten-sensitive enteropathy, is fairly common. One in 133 Americans has the disorder and needs to follow a gluten-free diet.

REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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