Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
What are the signs and symptoms of celiac disease?
The signs and symptoms of celiac disease vary depending on the degree of malabsorption, and ranges from no symptoms, few or mild signs and symptoms, to severe signs and symptoms. There are two categories of signs and symptoms: 1) signs and symptoms due to malabsorption, and 2) signs and symptoms due to malnutrition including vitamin and mineral deficiencies.
1. Signs and symptoms of malabsorption
The three major categories of dietary nutrients are carbohydrates, proteins,
and fat. Absorption of all of these nutrients can be reduced in celiac disease;
however, fat is the most commonly and severely affected nutrient. Most of the
gastrointestinal symptoms and signs
of celiac disease are due to the inadequate absorption of fat (fat malabsorption).
Gastrointestinal symptoms of fat malabsorption include diarrhea,
malodorous flatulence (foul smelling gas),
abdominal bloating, and increased amounts of fat in the stool (steatorrhea). The
unabsorbed fat is broken down by intestinal bacteria into
fatty acids, and these
fatty acids promote secretion of water into the intestine, resulting in
diarrhea. Fatty stools typically are large in volume, malodorous (foul
smelling), greasy, light tan or light grey in color, and tend to float in the
toilet bowl. Oil droplets (undigested fat) also may be seen floating on top of
the water.
Loss of intestinal villi also causes malabsorption of
carbohydrates, particularly the sugar lactose. Lactose is the primary sugar in milk. Lactose is
made up of two smaller sugars, glucose and galactose. In order for lactose to
be absorbed from the intestine and into the body, it must first be split into
glucose and galactose. The glucose and galactose can then be absorbed by the
cells lining the small intestine. The enzyme that splits lactose into glucose
and galactose is called lactase, and it is located on the
surface of the small intestinal villi. In celiac disease the intestinal villi
along with the lactase enzymes on their surface are destroyed, leading to the malabsorption of lactose.
The signs and symptoms of malabsorption of lactose are
particularly prominent in individuals with celiac disease who have an underlying lactose intolerance, a
genetically determined reduction in the activity of lactase. The symptoms of
lactose malabsorption (diarrhea, excessive flatulence [passing
gas], abdominal pain and abdominal
bloating or distension) occur because unabsorbed lactose passes through the
small intestine and into the colon. In the colon, the normal colony of bacteria contain lactase and
are able to split the lactose, and utilize the resulting
glucose and galactose for their own purposes. Unfortunately, when they split the
lactose into glucose and galactose, the bacteria also release gas (hydrogen and
/or methane). A proportion of the gas is expelled and is responsible for the
increased flatus (passing
gas) that may occur in celiac disease. Increased gas mixed in the stool is
responsible for the stools to float in the toilet bowl.
Not all of the lactose that reaches the colon is split
and used by the colonic
bacteria. The unsplit lactose that reaches the colon causes water to be drawn
into the colon (by osmosis). This promotes diarrhea.
2. Signs and symptoms of malnutrition and vitamin or mineral deficiencies
Symptoms of malnutrition and vitamin or mineral
deficiencies include: weight loss, fluid retention, anemia, osteoporosis,
bruising easily, peripheral neuropathy (nerve damage), infertility, and muscle
weakness.
Weight loss and fluid retention: Weight loss is the direct result of
inadequate absorption of carbohydrates, proteins and fat. However, weight loss
may not always occur because individuals with celiac disease often have an enormous
appetite that compensates for the reduced absorption of nutrients. Moreover,
weight loss can be masked by fluid retention. Fluid retention occurs in advanced
malnutrition because the reduced absorption of proteins results in low protein
levels in the blood. Normal protein levels in the blood are necessary to keep
fluid from leaking out of blood vessels and into the body's tissues. When
blood protein levels fall as in celiac disease, fluid leaks into many tissues
(edema) but particularly the ankles
and feet, which swell due to the edema.
Anemia: Lack of absorption of
vitamin B12 and iron can lead to
anemia.
Osteoporosis: Lack of absorption of vitamin D and calcium can lead to
osteoporosis and bone fractures.
Easy bruising: Lack of absorption of vitamin K can lead to diminished
ability of blood to clot and hence to
easy bruising or excessive bleeding.
Peripheral neuropathy (nerve damage):
Deficiencies of vitamins B12 and
thiamine may contribute to nerve damage with symptoms of poor balance, muscle weakness, and
numbness and tingling in the arms and legs.
Infertility: Untreated celiac disease can lead to
infertility in women, lack of
menses (menstruation), spontaneous
abortions and low birth weight infants.
Muscle weakness: Lack of absorption and
low levels of potassium
and magnesium can lead to severe muscle weakness,
muscle cramps, and numbness or
tingling sensations in the arms and legs.
Abnormal liver tests: For unclear reasons, patients with celiac disease may have
abnormal blood tests that suggest liver injury, specifically, elevated levels of aspartate amino transferase (AST) and/or leucine amino transferase (ALT). Occasionally, abnormalities of these tests may lead to a suspicion and subsequently a diagnosis of celiac disease.
Celiac Disease - Symptoms at Onset of DiseaseQuestion: The symptoms of celiac disease can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Gas or "intestinal gas" means different things to different people. Everyone has gas and eliminates it by belching or farting (passing it through the rectum).
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
In lactose intolerance, the digestive system cannot digest lactose (the main sugar in milk). Symptoms of lactose intolerance include diarrhea, flatulence, abdominal pain, abdominal bloating, abdominal distention, and nausea. There are several tests to diagnose lactose intolerance. Treatment is generally made with dietary changes, supplements, and adaptation to small amounts of milk.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestine. There are many conditions associated with small intestinal bacterial overgrowth, to include: diabetes, scleroderma, Crohn's disease, and others. There is a striking similarity between the symptoms of irritable bowel syndrome and SIBO. It has been theorized that SIBO may be responsible for the symptoms of at least some patients with irritable bowel syndrome. Symptoms of SIBO include: excess gas, abdominal bloating, diarrhea, and abdominal pain.
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
The most common food allergies are to eggs, nuts, milk, peanuts, fish, shellfish, strawberries and tomatoes. Symptoms and signs include nausea, vomiting, diarrhea, abdominal pain, itching, hives, eczema, asthma, lightheadedness, and anaphylaxis. Allergy skin tests, RAST, and ELISA tests may be used to diagnose a food allergy. Though dietary avoidance may be sufficient treatment for mild allergies, the use of an Epipen may be necessary for severe food allergies.
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, meralgia paresthetica, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Most causes of peripheral neuropathy can be successfully treated or prevented.
Pernicious anemia is a blood disorder in which the body does not make enough red blood cells due to a lack of vitamin B12 in the blood. Pernicious anemia can develop from a lack of a protein that helps the body absorb vitamin B12, not getting enough B12 in the diet, and certain intestinal conditions that interfere with the absorption of vitamin B12 such as Crohn's disease, celiac sprue, or ulcerative colitis. There is no cure for pernicious anemia, thus treatment is life-long.
There are many types of thyroid disease. Some occur due to the function of the thyroid itself such as hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, etc. Some causes of thyroid disease occur due to problems with the structure of the thyroid gland such as goiters, thyroid nodules, and thyroid cancer. Treatment of thyroid disease depends on the cause of the disease.
Canker sore is a small ulcer crater in the lining of the mouth. Canker sores are one of the most
common problems that occur in the mouth. Canker sores typically last for
10-14 days and they heal without leaving a scar.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Infertility is the diminished ability to conceive a child. The primary cause of infertility in men is a sperm disorder. In women, the primary cause of infertility is an ovulation disorder. Most forms of infertility can be treated. Conventional infertility therapies include drugs or surgery.
Osteopenia is a bone condition characterized by bone loss that is not as severe as in osteoporosis. Bone fracture is the typical symptom of osteopenia, though the condition may be present without symptoms. Treatment involves lifestyle modifications (quitting smoking, not drinking in excess) and ensuring an adequate intake of vitamin D and calcium.
Patients with celiac disease are required to eat a gluten-free diet. Gluten is found in rye, barley, and wheat. Gluten damages the intestine in patients with celiac disease. Some mediations contain gluten, so careful monitoring of products consumed is imperative. Patients with celiac disease are also at risk for developing nutritional deficiencies. The information in this article contains both foods that contain gluten, and foods that do not contain gluten.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Vitamin D deficiency has been linked with rickets, cancer, cardiovascular disease, severe asthma in children and cognitive impairment in older adults. Causes include not ingesting enough of the vitamin over time, having limited exposure to sunlight, having dark skin, and obesity. Symptoms include bone pain and muscle weakness. Treatment for vitamin D deficiency involves obtaining more vitamin D through supplements, diet, or exposure to sunlight.
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