Symptoms of coeliac disease

The symptoms of coeliac disease are very diverse, and can often be vague or mild. Mis-diagnosis and delayed diagnosis of coeliac disease are therefore common (1), with many patients showing signs that can easily be confused with other conditions such as Irritable Bowel Syndrome (IBS).

The range of symptoms is now known to be far more diverse than the “classic” symptoms that were previously described i.e. weight loss and diarrhoea. Many patients with coeliac disease are not under-weight, and in fact a significant proportion have a BMI of over 25 (2). Less than half present with diarrhoea (3). Previously only the most ill patients were diagnosed, and those with mild symptoms were missed, or were not diagnosed until their symptoms worsened.

Other symptoms to look out for include:

• Abdominal pain and bloating
• Anaemia (most commonly Fe or folate, but also B12)
  • Aphthous mouth ulcers
  • Tiredness
• Dermatitis herpetiformis
• Osteoporosis
• Depression
• Muscle weakness
• Bone pain
• Infertility and recurrent miscarriage
• Amenorrhea

Children may present with loss of appetite, failure to thrive, unhappy/clingy behaviour, abdominal distension, small stature, muscle wasting.

If a patient presents with any of these symptoms coeliac disease should be suspected and the relevant tests carried out.

References

(1)Shahbazkhani B, Forootan M, Merat S et al. Coeliac Disease presenting with symptoms of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics 2003;18(2):231-5

(2)Dickey W, Bodkin S. Prospective study of body mass index in patients with coeliac disease. BMJ 1998;317: 1290

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