Some people with celiac disease have no symptoms at all, but still test positive on the celiac disease blood test. Others may have a negative blood test, but have a positive intestinal biopsy. However, all people with celiac disease are at risk for long-term complications, whether or not they display any symptoms.
Classical, Non-classical, and Silent Celiac Disease
According to the World Gastroenterology Organization, celiac disease may be divided into two types: classical and non-classical.
In classical celiac disease, patients have signs and symptoms of malabsorption, including diarrhea, steatorrhea (pale, foul-smelling, fatty stools), and weight loss or growth failure in children.
In non-classical celiac disease, patients may have mild gastrointestinal symptoms without clear signs of malabsorption or may have seemingly unrelated symptoms. They may suffer from abdominal distention and pain, and/or other symptoms such as: iron-deficiency anemia, chronic fatigue, chronic migraine, peripheral neuropathy (tingling, numbness, or pain in hands or feet), unexplained chronic hypertransaminasemia (elevated liver enzymes), reduced bone mass and bone fractures, and vitamin deficiency (folic acid and B12), difficulty losing weight, late menarche/early menopause and unexplained infertility, dental enamel defects, depression and anxiety, dermatitis herpetiformis (itchy skin rash), etc.
First-degree relatives should always be screened, since there is a 1 in 10 risk of developing celiac disease.
Silent celiac disease is also known as asymptomatic celiac disease. Patients do not complain of any symptoms, but still experience villous atrophy damage to their small intestine. Studies show that even though patients thought they had no symptoms, after going on a strict gluten-free diet, they report better health and a reduction in acid reflux, abdominal bloating, and distention and flatulence.
First-degree relatives, whether or not experiencing symptoms, should always be screened, since there is a 1 in 10 risk of developing celiac disease. Second-degree relatives also have an increased risk of developing the disease.
The number of ways celiac disease can affect patients, combined with a lack of training in medical schools and primary care residency programs, contributes to the poor diagnosis rate in the United States. Currently, it is estimated that 80% of the celiac disease population remains undiagnosed.
