Celiac Symptoms and Diagnosis

What are the signs and symptoms of celiac disease?

A person may experience digestive signs and symptoms, or symptoms in other parts of the body. Digestive signs and celiac symptoms are more common in children and can include:

abdominal bloating
chronic diarrhea
constipation
gas
pale, foul-smelling, or fatty stool
stomach pain
nausea
vomiting

Being unable to absorb nutrients during the years when nutrition is critical to a child’s normal growth and development can lead to other health problems, such as:

failure to thrive in infants
slowed growth and short stature
weight loss
irritability or change in mood
delayed puberty
dental enamel defects of permanent teeth


Adults are less likely to have digestive signs and symptoms and may instead have one or more of the following:

anemia
bone or joint pain
canker sores inside the mouth
depression or anxiety
dermatitis herpetiformis, an itchy, blistering skin rash
fatigue, or feeling tired
infertility or recurrent miscarriage
missed menstrual periods
seizures
tingling numbness in the hands and feet
weak and brittle bones, or osteoporosis
headaches

Intestinal inflammation can cause other celiac symptoms, such as

feeling tired for long periods of time
abdominal pain and bloating
ulcers
blockages in the intestine

Celiac disease can produce an autoimmune reaction, or a self-directed immune reaction, in which a person’s immune system attacks healthy cells in the body. This reaction can spread outside of the gastrointestinal tract to affect other areas of the body, including the

spleen
skin
nervous system
bones
joints

Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases and conditions. Celiac disease can be confused with:

irritable bowel syndrome (IBS)
iron-deficiency anemia caused by menstrual blood loss
lactose intolerance
inflammatory bowel disease
diverticulitis
intestinal infections
chronic fatigue syndrome

As a result, celiac disease has long been underdiagnosed or misdiagnosed. As health care providers become more aware of the many varied symptoms of the disease and reliable blood tests become more available, diagnosis rates are increasing, particularly for adults.

How is celiac disease diagnosed?

A health care provider diagnoses celiac disease with

a medical and family history
a physical exam
blood tests
an intestinal biopsy
a skin biopsy
Medical and Family History
Taking a medical and family history may help a health care provider diagnose celiac disease. He or she will ask the patient or caregiver to provide a medical and family history, specifically if anyone in the patient’s family has a history of celiac disease.

Physical Exam

A physical exam may help diagnose celiac disease. During a physical exam, a health care provider usually examines the patient’s body for malnutrition or a rash uses a stethoscope to listen to sounds within the abdomen taps on the patient’s abdomen checking for bloating and pain

Blood Tests

A blood test involves drawing blood at a health care provider’s office or a commercial facility and sending the sample to a lab for analysis. A blood test can show the presence of antibodies that are common in celiac disease.

If blood test results are negative and a health care provider still suspects celiac disease, he or she may order additional blood tests, which can affect test results.

Before the blood tests, patients should continue to eat a diet that includes foods with gluten, such as breads and pastas. If a patient stops eating foods with gluten before being tested, the results may be negative for celiac disease even if the disease is present.

Intestinal Biopsy

If blood tests suggest that a patient has celiac disease, a health care provider will perform a biopsy of the patient’s small intestine to confirm the diagnosis. A biopsy is a procedure that involves taking a piece of tissue for examination with a microscope. A health care provider performs the biopsy in an outpatient center or a hospital. He or she will give the patient light sedation and a local anesthetic. Some patients may receive general anesthesia.

During the biopsy, a health care provider removes tiny pieces of tissue from the patient’s small intestine using an endoscope—a small, flexible camera with a light. The health care provider carefully feeds the endoscope down the patient’s esophagus and into the stomach and small intestine. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. The health care provider then takes the samples using tiny tools that he or she passes through the endoscope. A pathologist—a doctor who specializes in examining tissues to diagnose diseases—examines the tissue in a lab. The test can show damage to the villi in the small intestine.

Symptoms01

Skin Biopsy

When a health care provider suspects that a patient has dermatitis herpetiformis, he or she will perform a skin biopsy. A skin biopsy is a procedure that involves removing tiny pieces of skin tissue for examination with a microscope. A health care provider performs the biopsy in an outpatient center or a hospital. The patient receives a local anesthetic; however, in some cases, the patient will require general anesthesia.


A pathologist examines the skin tissue in a lab and checks the tissue for antibodies that are common in celiac disease. If the skin tissue tests positive for the antibodies, a health care provider will perform blood tests to confirm celiac disease. If the skin biopsy and blood tests both suggest celiac disease, the patient may not need an intestinal biopsy for diagnosis.