What are the symptoms of coeliac disease in adults and children?

Coeliac disease is a common disease, but one that manifests itself with symptoms that are not always easy to spot. Many people suffer from this disease, and in many cases without knowing it. But how to detect it? What are the symptoms of the coeliac condition in adults and children?

What is the coeliac condition?

The coeliac condition is an autoimmune condition characterised by an inflammatory response that affects certain genetically predisposed individuals when they consume the gluten protein complex, which is contained in certain cereals or elements contaminated by them.

Gluten, and in particular a substance it contains, gliadin, activates the immune system, which acts by producing antibodies and mistakenly attacking the mucous membrane of the intestine.

This leads to inflammation and damage to the intestinal mucosa, which varies from individual to individual, including atrophy (i.e. reduction) of the ‘vili’, the finger-like growths necessary for the absorption of nutrients from food.

Their atrophy leads to nutrient deficiencies and malabsorption.

At what age does the coeliac condition manifest itself?

The coeliac condition does not always develop in genetically predisposed individuals.

When the disease does occur, however, it can occur at any age, due to a combination of factors, some of which have not yet been identified.

Celiac disease: the causes

The causes of the coeliac condition, as indicated, are not entirely known, but it is thought to be a mixture of factors, including

  • genetic predisposition and familiarity, especially in the first degree of kinship (parents, children, brothers and sisters) as some variations in the genes involved in the development of the disease can be passed on to their descendants;
  • environmental factors such as infections of the digestive system (rotavirus etc.);
  • autoimmune diseases such as diabetes, thyroid disorders, etc.: according to data from the ISS, these can increase the risk of developing the coeliac condition by up to 10 times compared to the general population.

Symptoms of the coeliac disease

The symptoms of the coeliac condition vary greatly, depending on the severity of the condition, and in some cases there may even be no clinical manifestations.

The first symptom, understood to be the most common of the typical form of the disease, is diarrhoea, caused by the inability of the inflamed body to fully absorb nutrients.

Symptoms of coeliac disease in adults

Apart from diarrhoea, the other characteristic symptoms of the coeliac condition that can be detected in adults are mainly

  • abdominal bloating
  • meteorism
  • weight loss;
  • dehydration.

Symptoms of the coeliac condition in children

As far as children are concerned, the coeliac condition (which, if clinical manifestations are present, can present with the same symptoms as adults) and malabsorption of nutrients can alter the child’s developmental curve with consequences that are sometimes themselves telltale signs of the disease, such as:

  • slower growth and pubertal development;
  • short stature;
  • underweight;
  • incomplete development or a reduction in dental enamel (hypoplasia);
  • rickets, i.e. reduced mineralisation of the bones, making them more fragile and thus more susceptible to deformities and fractures;
  • lethargy, i.e. a feeling of constant drowsiness, lack of energy and profound exhaustion.

Atypical symptoms of the coeliac condition

The coeliac condition, however, is increasingly presenting itself in atypical forms, with purely extra-intestinal complaints that make it difficult to identify, such as, for example

  • severe and persistent tiredness (asthenia);
  • difficulty in concentrating
  • anaemia;
  • consistent and widespread hair loss (alopecia);
  • recurrent ulcers and mouth ulcers;
  • frequent abdominal pain;
  • repeated episodes of vomiting;
  • headache;
  • menstrual cycle dysfunction, infertility or miscarriage;
  • numbness and tingling sensation in the peripheral limbs (hands and feet) with ataxia, i.e. a progressive loss of the ability to coordinate muscles and their activity.

Celiac disease and skin symptoms: dermatitis herpetiformis

In some people, instead of the classic intestinal inflammation, coeliac disease can lead to what is commonly referred to as ‘cutaneous coeliac disease’, the scientific name for which is Duhring’s dermatitis herpetiformis or Brocq’s painful polymorphous dermatitis.

Dermatitis herpetiformis is characterised by itchy blisters that frequently develop on the elbows and knees, but can also appear on any area of the skin such as the armpits, scalp etc.

Other forms of the coeliac condition

To complete the picture of the coeliac condition as a fairly complex disease, in addition to forms with typical symptoms and those with atypical symptoms there are others:

  • silent coeliac disease: the disease is present, i.e. the intestinal villi are atrophied, but no symptoms are manifested. In this case, considering a predisposition for first-degree relatives of coeliacs to develop the disease of about 15% more than the general population, if there are cases of coeliacs in a close relationship it would be advisable to carry out diagnostic tests.
  • latent coeliac condition: the patient has a positive diagnosis for the disease, but presents a normal intestinal mucosa, without atrophy of the villi, with alterations that will tend to develop over the years.
  • Potential coeliac condition: in individuals who have a genetic predisposition, and therefore have a risk of developing the disease with consequent atrophy of the villi and malabsorption, but are still negative in the diagnostic tests carried out and have a normal intestinal mucosa.

Coeliac disease and weight gain

Celiac disease is also often heard of as being linked to weight gain, but no correlation has been proven.

The metabolism may be slowed down by thyroid disease, which may be the cause of the coeliac condition, and at the same time it may be possible to gain weight after the coeliac condition has been detected and the cause of malabsorption eliminated.

Gluten sensitivity and coeliac disease

The typical and atypical symptoms of the coeliac condition, mentioned above, can also occur in individuals with a negative diagnosis of the disease and a normal intestinal mucosa.

In this case we are talking about simple gluten sensitivity, i.e. an intolerance which, like the coeliac condition, varies in intensity from individual to individual, but which, unlike the coeliac condition which is lifelong, can resolve completely after the discontinuation of gluten for 1-2 years.

The immune system of individuals with Gluten Sensivity reacts within hours of eating gluten, which is perceived as a threat, whereas in coeliac disease the reaction and damage can occur after a build-up period of months or even years.

Gluten sensitivity is about 6 times more common than coeliac disease, but to date there are no tests to detect it accurately.

The only immunological alteration that can be found in patients with gluten sensitivity is a positive blood test for certain antibodies (first-generation AGA, class IgG, more rarely class IgA), which are found positive in 40-50% of patients with this condition.

On a genetic level, Gluten Sensitivity is positive for certain genetic markers (for HLA-DQ2 and/or DQ8) in approximately 50% of cases, compared to 99% of coeliacs and 30% of the general population.

Coeliac disease, gluten sensitivity and irritable bowel syndrome (IBS)

People suffering from hypersensitivity to gluten (Gluten Sensitivity) present symptoms very similar to those of Irritable Bowel Syndrome (IBS) such as bloating and abdominal pain, irregular bowel movements, etc..

Therefore, this new clinical entity, Gluten Sensitivity, may also include some patients who may have been mistakenly considered as suffering from irritable bowel syndrome, hypochondriacs or with psychological and anxiety-depressive problems.

In any case, it should also be stressed that Gluten Sensitivity is unfortunately not yet ‘understood’ by many specialists who prefer to ‘label’ as suffering from irritable bowel syndrome (sometimes difficult to control) people who actually suffer from a sensitivity to gluten (easier to control).

Celiac disease or wheat allergy?

These are different diseases because, unlike coeliac disease, a wheat allergy can be triggered not only in the intestinal area but can also affect, for example, the airways, the skin, as well as leading to anaphylactic shock in the most severe cases.

In the case of a wheat allergy, the consumption of wheat alone should be avoided, while there are many cereals that contain gluten, including oats, barley, rye, spelt and kamut.

In any case, to facilitate a differentiated diagnosis, tests can be carried out to detect wheat allergy through the presence or absence of certain IgE class antibodies and PRICK tests.

Complications of coeliac disease

Missed or late diagnosis and prolonged consumption of gluten-containing foods in coeliacs can lead to various complications, including

  • tumours and intestinal diseases: the risk of developing neoplasms such as intestinal carcinoma and non-HodgKing’s lymphoma, or ulcerative jejunalitis, which results in the appearance of ulcers in the wall of the intestine, increases with advancing age;
  • diseases affecting: central and peripheral nervous system; cardiovascular system; endocrine system; liver; skin;
  • atrophy of the spleen and reduced spleen function (hyposplenism) with an increased susceptibility to infection;
  • lactose intolerance, which usually resolves, however, a few months after starting the gluten-free diet;
  • persistence of symptoms: in less than 1% of cases the symptoms and inflammation do not resolve even after eliminating gluten from the diet, with the occurrence, for example, of collagenous sprue, a chronic benign inflammation of the intestine characterised by diarrhoea and watery stools.


The diagnosis of coeliac disease is made by means of blood tests and a duodenal biopsy.

Obviously these investigations must be carried out when the patient is on a gluten-free diet.

Blood tests

Blood tests are used to determine the level of certain antibodies produced by the immune system when gluten is perceived as a harmful substance:

  • anti-transglutaminase (of the IgA class);
  • anti-endomysium (EMA) and anti-gliadin (AGA), replacing and/or complementing anti-transglutaminases.

Intestinal biopsy

If the blood sample is positive, a duodenal biopsy is usually performed during oesophago-gastro-duodenoscopy to assess the condition of the intestinal villi (which are then examined under a microscope to see whether or not signs of the disease are present).

According to the most recent guidelines, biopsy can be avoided in children and adolescents with high antibody values (more than 10 times the baseline value) and typical symptoms of the disease.

The genetic test

When the antibody dosage, duodenal biopsy and symptoms do not give clear results, genetic testing is carried out by DNA examination.

This procedure detects whether you are predisposed to the disease through the presence of the HLA-DQ2 and HLA DQ8 genes.

Being positive in the genetic test does not mean that you are coeliac, but it does mean that you are more likely to develop the coeliac condition than the general population.

A negative genetic test, on the other hand, makes it highly unlikely that the patient will develop coeliac disease.

Once the diagnosis of coeliac disease has been confirmed, checks should be made over time to assess the state of inflammation, including malabsorption, anaemia and bone health.

Treatment of coeliac disease

To date, the only cure for coeliac disease is a completely gluten-free diet, taking care not only to avoid cereals that contain gluten, but also foods that may be contaminated with it or contain it as an additive.

The gluten-free diet does not in itself entail any nutritional deficiencies, but it is necessary to follow a balanced diet rich in fruit and vegetables, and it may be advisable to consult a nutritionist in order to develop this.

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