Non-classic celiac more severe

Complementing this study on non-classic celiac symptoms delaying diagnosis, research from Finland shows most celiac children have non-intestinal symptoms upon diagnosis. Those diagnosed because of non-intestinal problems show more severe symptoms and damage to the small intestine than children presenting mainly classic symptoms (see Extraintestinal Celiac Symptoms in Kids).

The study included 511 children with biopsy-proven celiac. The main reasons for suspected celiac were classic symptoms like diarrhea and abdominal pain in 49 percent and non-intestinal conditions in 23 percent, while 29 percent were diagnosed after screening because of risk factors like family history. Researchers compared children with celiac to 180 children diagnosed with functional gastrointestinal disorders like irritable bowel syndrome without evidence of tissue damage.

The symptoms

Non-gastrointestinal complaints included skin rashes, anemia, poor growth, enamel defects, nerve problems, headaches, joint pain, mouth sores, elevated liver enzymes, eye problems and other conditions. Poor growth and anemia were most common, affecting 27 and 18 percent of children with celiac, respectively. Patients with celiac were almost twice as likely to have non-intestinal conditions as children with functional disorders: 62 compared to 33 percent.

Disease severity

On endoscopy and biopsy, children who had non-intestinal complaints showed the most severe damage to the small intestine. Symptoms were more severe in 78 percent diagnosed because of non-intestinal conditions compared to 45 percent presenting primarily classic symptoms.

These two studies highlight a need for further research to understand the prevalence of various non-classic symptoms associated with celiac. Meanwhile, doctors should consider celiac as an underlying cause.

Nurminen S, Kivela L, Huhtala H, Kaukinen K and Kurppa K, “Extraintestinal manifestations were common in children with coeliac disease and were more prevalent in patients with more severe clinical and histological presentation,” Acta Paediatrica, March 2018,

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