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Celiac disease can affect virtually every organ. Presentation falls into three broad categories: classic, non-classic, and subclinical.
Important: Many people consider themselves asymptomatic but have actually adapted to chronically compromised health. After starting a GFD, they retrospectively recognise symptoms they had previously accepted as normal.
Gastrointestinal (Classic)
Most characteristic in young children, but can affect any age.
- Chronic diarrhea — pale, large-volume, foul-smelling
- Abdominal pain and cramping
- Bloating and abdominal distension
- Mouth ulcers
- Weight loss / failure to thrive
- Malabsorption
- Lactose intolerance (can develop secondary to bowel damage)
Extraintestinal (Non-Classic)
Celiac is a systemic disorder — these arise from malabsorption or systemic inflammation:
Neurological
- Headaches
- Fatigue, brain fog
- Muscle pain, joint pain
- Peripheral neuropathy
- Epilepsy
- Gluten ataxia (cerebellar)
Musculoskeletal / Bone
- Low bone mass density (osteopenia)
- Osteoporosis — from malabsorption, inflammation, and autoimmunity
- Elevated fracture risk
Nutritional Deficiencies
| Nutrient | Consequence |
|---|---|
| Iron | Anemia (most common extraintestinal presentation) |
| Folate | Anemia, neural tube risk |
| Zinc | Reproductive disorders |
| Vitamin D | Secondary hyperparathyroidism |
| Vitamin B12 | Neurological symptoms |
| Calcium | Bone disease |
| Selenium | Reproductive issues |
Endocrine / Reproductive
- Delayed puberty, delayed periods
- Infertility (both sexes)
- Spontaneous abortion, intra-uterine growth restriction
- Associated with type 1 diabetes and autoimmune thyroid disease
Hepatic
- Celiac hepatitis — mildly elevated transaminases, no other cause; resolves on GFD
Skin
- Dermatitis herpetiformis — blistering rash, pathognomonic for gluten sensitivity
Rare Manifestations
- Psoriasis
- Recurrent aphthous stomatitis
- Pericardial effusion
- Lane-Hamilton syndrome
Complications (Untreated)
- Iron-deficiency anemia
- Osteoporosis
- Infertility
- Cancers (oropharynx, esophagus, small intestine lymphoma)
- Enteropathy-associated T-cell lymphoma (EATL) — rare but serious
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