 | Coeliac disease: Encyclopedia II - Coeliac disease - Signs and symptoms
Coeliac disease - Signs and symptoms
Damage to the villi reduces the ability of the intestines to absorb nutrients, and it is believed that the resulting nutritional deficiencies likely cause the wide spectrum of symptoms associated with the disorder. Coeliac disease may lead to digestive problems, such as indigestion, heartburn and irritable bowel syndrome, unexplained weight loss or other signs of nutritional deficiency due to malabsorption, and a wide range of other problems in different bodily systems, including the nervous system, the heart, and the teeth and bones.
Other symptoms can include dermatitis (an itchy rash), diarrhea, excessive tiredness or fatigue, aching in joints and a general feeling of being unwell.
Coeliacs (people with coeliac disease) may also be symptom-free, but they are still doing damage to their small intestines. Regardless of the presence or absence of symptoms, the disorder is associated with an increased risk of osteoporosis and MALT lymphoma, a form of intestinal cancer.
Strict adherence to a gluten-free diet typically resolves all symptoms and conditions caused by coeliac disease. In coeliacs who are not on a gluten-free diet, the disease may present through one or more of the following symptoms. The presence of these symptoms does not mean the individual is coeliac. These symptoms are also associated with other diseases, some of which are life-threatening; therefore, patients with these symptoms should promptly consult a doctor for differential diagnosis.
Dietary deficiencies, which may manifest as symptoms in particular body systems (e.g., digestive or nervous system) or may be noticed on routine blood tests, are common in coeliacs. Up to 50% of coeliac disease patients have malabsorption-related diarrhea (with bulky, pale, offensive-smelling stools which may float in the toilet bowl). This symptom is known as steatorrhea. However, some coeliacs suffer from constipation. Excess flatulence is common, and some coeliacs also experience infrequent, minor rectal bleeding. Unexplained weight loss (or even obesity occasioned by overeating due to cravings for nutrients), indigestion, acid reflux, excessive tiredness (coeliacs have reported falling asleep while driving) and an itchy rash (dermatitis) may also be a sign of the disorder. Delayed puberty (or short stature prior to adolescence) might also be a symptom. Rarely, coeliacs may experience symtoms similar to those of sinus infections and/or the formation of thick, choking plugs or ropes of mucus that require considerable effort to expel. A low-grade, persistent pain may be present, possibly lessened by eating, which may all too easily be taken for the presence of ulcers.
In young children, the most common symptoms are steatorrhoea, weight loss, abdominal distension, and slow growth/failure to thrive, but irritability, vomiting and tiredness are common. It has been suggested that some cases of autism may be caused by coeliac disease.
In adults, the symptoms of coeliac disease may be mistaken for irritable bowel syndrome (IBS) or an inflammatory bowel disease such as Crohn's disease. However, coeliac disease is also associated with anemia, cardiomyopathy, depression, fatigue and "mental fog," dental problems (see below), adverse pregnancy outcome (particularly miscarriage), peripheral neuropathy, and according to some studies, schizophrenia. A very high proportion of patients diagnosed with dermatitis herpetiformis are coeliacs.
Selective dietary deficiencies such as dietary iron deficiency, vitamin B12 deficiency, osteoporosis (due to Vitamin D and calcium malabsorption), poor thyroid function, or other secondary dietary deficiencies may be the sole symptom (predominantly in older patients), or found in addition to diarrhea or weight loss. Some coeliacs experience dental problems as a result of malabsorption of nutrients essential for dental health. Coeliacs who have dental symptoms typically have tooth enamel problems, which manifest primarily as discoloration and/or severe tooth decay. A pattern of symmetrical decay is particularly associated with coeliac disease.
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