Celiac Disease: Symptoms, Complaints, Signs

First symptoms may develop shortly after the introduction of complementary food! The classic symptoms (diarrhea and failure to thrive) show, however, only about 20% of sufferers. Consequential diseases in later (small) childhood often lead to the diagnosis. Note: Screening examinations in children show that 50 to 70 % of those affected are symptom-free [2. 3]. Celiac disease (gluten-induced enteropathy) is associated with the following symptoms and complaints:

Intestinal (“affecting the intestines”).

  • Constant watery diarrhea (diarrhea); in full-blown infants, also symptoms such as voluminous foul-smelling diarrhea [motility disorders in the sense of constipation/constipation may also occur).
  • Chronic abdominal pain*
  • Meteorism* (bloated abdomen)
  • Expansive abdomen
  • Steatorrhea – gray shiny fatty stools or diarrhea, respectively.
  • Nausea (nausea) and / or vomiting.
  • Loss of appetite in gastroparesis (gastric paralysis: delayed gastric emptying).

* 75% of patients suffer from abdominal pain and meteorism; more than half of celiac patients are misdiagnosed and -treated as irritable bowel syndrome (IBS) in the long term, another third as a mental disorder!Some patients suffer from nonspecific symptoms such as chronic constipation (constipation) or abdominal pain. Extraintestinal (“outside the gut“).

Celiac disease should also be considered if the following extraintestinal symptoms are present:

  • Weight loss/unwanted weight loss (general malabsorption).
  • Growth and failure to thrive (in infants)/growth retardation.
    • Failure to thrive in infancy; in full-blown infancy, also symptoms, such as muscle hypotrophy (underdeveloped muscles) and anorexia (loss of appetite)
    • Pubertas tarda (is present when in the otherwise healthy girl (boy) beyond a chronological age of 13.5 (14) years, pubertal signs are not yet present)
  • Deficiency syndromes of macro- and micronutrients (nutrients, vital substances) – especially fat-soluble vitamins – due to losses through the stool, as well as absorption disorders; leads to:
    • Anemia (iron deficiency anemia; anemia) / pallor due to iron deficiency.
    • Hematomas due tovitamin K deficiency
    • Night blindness due tovitamin A deficiency
    • Edema (water retention) due tohypalbuminemia
    • Osteomalacia (bone softening)/osteoporosis (bone loss) due tocalcium and vitamin D deficiency.
    • Peripheral neuropathy (disease of the nerves which carry information between the central nervous system and the muscles)/polyneuropathy (disorders of the peripheral nerves or parts of nerves) due tovitamin B12 deficiency
    • Tetany / muscle weakness due tomagnesium and calcium deficiency.
    • Tooth enamel changes due tocalcium deficiency
  • Recurrent oral aphthae – painful, erosive mucosal changes that occur preferentially in the oral cavity in the area of the gums, oral mucosa or tongue.
  • Neurological disorders:
    • Headache and migraine, respectively (prevalence (disease frequency): 21-28%; mainly affects women younger than 65 years).
    • Risk for patients with celiac disease to develop epilepsy in the future was significantly increased (in children HR 1.42 and in adolescents (age < 20 years) 1.58)
  • Some celiacs further complain of psychological changes (depressed mood), listlessness, fatigue, poor concentration and performance, and depression.

Clinical picture in relation to age

The clinical picture of celiac disease in relation to age:

  • In children under three years of age, typical gastrointestinal symptoms (symptoms of the gastrointestinal tract) such as diarrhea (diarrhea), abdominal pain (abdominal pain) and failure to thrive predominate.
  • In older children, on the other hand, are gastrointestinally asymptomatic. They often have non-gastrointestinal conditions such as type 1 diabetes, thyroiditis (inflammation of the thyroid gland), short stature, and a positive family history of celiac disease or iron deficiency anemia.
  • In adults today, oligo- or even monosymptomatic courses and extraintestinal (“outside the intestine”) manifestations are in the foreground (e.g..B. Iron deficiency anemia, oral aphthae, dermatitis herpetiformis (skin disease from the group of blistering autoimmune dermatoses), osteopenia (reduction in bone density), transaminase elevation and secondary amenorrhea/no menstrual bleeding for more than three months with an already established cycle).

Screening of patients at risk

Extraintestinal manifestations of celiac disease:

Asymptomatic/atypical manifestations. Percent (%)
First degree relatives 15-20 %
Down syndrome 5-12 %
Ullrich-Turner syndrome 2-5 %
Diabetes mellitus type 1 2-12 %
Autoimmune hepatitis (children) 12-13 %
Autoimmune thyroiditis 3-7 %
Selective Ig A deficiency 2-8 %

Oligosymptomatic symptoms:

  • Anorexia (loss of appetite).
  • Chronic/intermittent diarrhea (diarrhea).
  • Chronic headache
  • Chronic fatigue
  • Chronic constipation
  • Depressive mood
  • Dyspetic complaints (vomiting/nausea)
  • Iron deficiency anemia
  • Failure to thrive
  • Weight loss
  • Short stature/growth retardation
  • Osteoporosis/osteopenia
  • Concentration disorders
  • Pubertas tarda (amenorrhea)
  • Recurrent oral aphthae
  • Transaminase elevation
  • Enamel defect

Refractory celiac disease type II – exclusion of intestinal (bowel-related) malignancy (lymphoma)

This is usually accompanied by the following clinical alarm symptoms:

  • Night sweats
  • Progressive weight loss
  • Fever