Symptoms of coeliac disease

Symptoms of coeliac disease range from vague or mild to severe, with many patients showing signs that can easily be confused with other conditions such as Irritable Bowel Syndrome (IBSIrritable bowel syndrome - a common but poorly understood chronic (long-term) condition where the normal functions of the bowel are disrupted).  Misdiagnosis and delayed diagnosis of coeliac disease is common (1).

The National Institute for Health and Clinical Excellence (NICENational Institute for Health and Clinical Excellence - an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. NICE had produced a clinical guideline on the recognition and assessment of coeliac disease.) guideline on IBS in adults, published in February 2008, recommend that people who meet the IBS diagnostic criteria should have an antibody test to exclude coeliac disease should be undertaken (2).

Historically, weight loss and diarrhoea were commonly associated with coeliac disease. However, many patients are not underweight, and in fact a significant proportion have a body mass index (BMI) of over 25 (3). Less than half present with diarrhoea (4). Previously only those patients with the most severe symptoms were diagnosed, and those with mild symptoms were missed, or were not diagnosed until their symptoms worsened.

In adults the most frequent symptoms observed are: 

• abdominal pain and bloating


• chronic or occasional diarrhoea


• tiredness


• iron-deficiency anaemia (but also folate and/or vitamin B12)


• nausea or vomiting


• weight loss.

The following features may also be present: 

•  abnormal liver biochemistry


• alopecia


• amenorrhoea


• aphthous mouth ulcers


• constipation


• dermatitis herpetiformisUsually shortened to DH, this is a form of coeliac disease where the skin is affected with small blisters. (DH)


• epilepsy


• microscopic colitis


• osteoporosisA condition where your bones lose bone mass and become brittle.


• recurrent miscarriages


• type 1 diabetes.

If a patient presents with any of these symptoms, coeliac disease is a possible diagnosis so serological testing should be offered.

References

1. Shahbazkhani B, Forootan M, Merat S, Akbari MR, Nasserimoghadam S, Vahedi H, Malekzadeh R. (2003). Coeliac Disease presenting with symptoms of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics 18(2):231-5

2. National Institute for Health and Clinical Excellence. Irritable bowel syndrome in adults, diagnosis and management of irritable bowel syndrome in primary care 2008  

3. Dickey W, Bodkin S. (1998). Prospective study of body mass index in patients with coeliac disease. BMJ317: 1290

4. Lo W, Sano K, Lebwohl B, Diamond B, Green PHR. (2003). Changing presentation of celiac disease.Digestive Disease Science 48:395–98