Coeliac Disease
Symptoms and Signs

Coeliac Disease

Coeliac disease is a common, systemic autoimmune disease caused by the ingestion of gluten, and can develop at any age.1,2 Its presentation is variable, partly because it has both a genetic and immunological basis; age of onset, dietary habits, and gender can all affect its clinical manifestation.1

The symptoms of different gastrointestinal conditions overlap considerably,3 making it difficult to identify the relevant condition. This lack of symptom specificity has likely contributed to the diagnostic delay of 10-13 years from onset of symptoms that patients with coeliac disease currently face.4,5

If you’re a GP looking after 2,000 patients, you can expect approximately 20 of your patients to have coeliac disease.1 On average, you could be seeing two patients with coeliac disease every week.

  • Prompt identification of these patients could improve their quality of life and reduce their risk of long-term complications.4,6

Symptoms of coeliac disease


Coeliac disease symptoms are typically divided into two classes: classical (gastrointestinal) and atypical (non-gastrointestinal).1

Classical symptoms

  • Nausea or vomiting (children)7
  • Diarrhoea3
  • Constipation3
  • Abdominal pain3
  • Flatus3
  • Weight loss1

Atypical symptoms

  • Failure to thrive (children)7
  • Behavioural issues (children)7
  • Delayed growth and puberty7
  • Fatigue8
  • Headaches8
  • Infertility or miscarriage9
  • Dermatitis herpetiformis9
  • Reduced bone density9
  • Damage to dental enamel9
  • Aphthous ulcers9
  • Joint stiffness and pain9
  • Gastro-oesophageal reflux8
  • Menstrual irregularities10
  • Early menopause10

Around half of adults with coeliac disease experience atypical symptoms, and these patients may get misdiagnosed or overlooked due to their non-gastrointestinal presentation.1


Coeliac disease symptoms are especially easily confused with those of irritable bowel syndrome (IBS),3 inflammatory bowel disease,11 or even lactose intolerance.3 28 percent of patients with coeliac disease first receive treatment for IBS.12

Serologic testing should be performed to rule out coeliac disease in patients with IBS and diarrhoea symptoms.13,14

Other gluten-related disorders

Coeliac disease shares characteristics with other gluten-related disorders, including non-coeliac gluten sensitivity (NCGS) and wheat allergy.15,16

Non-coeliac gluten sensitivity

The clinical presentation of NCGS is similar to that seen in coeliac disease. However, the symptoms usually appear soon after consumption of foods containing gluten and disappear when such foods have been removed from the diet.15

NCGS is a diagnosis of exclusion; a diagnosis should only be made after other gluten-related and non-gluten-related disorders have been ruled out.15

Wheat allergy

Symptoms of wheat allergy may include abdominal pain and vomiting, as well as typical allergy symptoms. Wheat allergy is most commonly seen in children and is usually outgrown by the age of 16 years.16

How to distinguish coeliac disease from diseases with similar symptoms

Serological tests can be used to help differentiate between diseases with similar gastrointestinal symptoms, potentially reducing the time to diagnosis.14,15,17

Tissue transglutaminase (tTG) IgA is the recommended first-line test for coeliac disease, together with total IgA to check for IgA deficiency.7

IgA: immunoglobulin A  

1. Gujral N, Freeman H J, Thomson A B. Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol 2012;18(42):6036-6059

2. Lauret E, Rodrigo L. Celiac disease and autoimmune-associated conditions. Biomed Res Int 2013;2013:127589

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4. Gray A M, Papanicolas I N. Impact of symptoms on quality of life before and after diagnosis of coeliac disease: results from a UK population survey. BMC Health Serv Res 2010;10:105

5. Norström F, Lindholm L et al. Delay to celiac disease diagnosis and its implications for health-related quality of life. BMC Gastroenterology 2011;11(1):118

6. Lundin K E, Wijmenga C. Coeliac disease and autoimmune disease-genetic overlap and screening. Nat Rev Gastroenterol Hepatol 2015;12(9):507-515

7. Al-Toma A, Volta U et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J 2019;7(5):583-613

8. Leffler D A, Dennis M et al. A validated disease-specific symptom index for adults with celiac disease. Clin Gastroenterol Hepatol 2009;7(12):1328-1334, 1334 e1321-1323

9. Leffler D A, Green P H, Fasano A. Extraintestinal manifestations of coeliac disease. Nat Rev Gastroenterol Hepatol 2015;12(10):561-571

10. Shah S, Leffler D. Celiac disease: an underappreciated issue in women's health. Womens Health (Lond) 2010;6(5):753-766

11. Pascual V, Dieli-Crimi R et al. Inflammatory bowel disease and celiac disease: overlaps and differences. World J Gastroenterol 2014;20(17):4846-4856

12. Card T R, Siffledeen J et al. An excess of prior irritable bowel syndrome diagnoses or treatments in celiac disease: evidence of diagnostic delay. Scand J Gastroenterol 2013;48(7):801-807

13. Moayyedi P, Mearin F et al. Irritable bowel syndrome diagnosis and management: a simplified algorithm for clinical practice. United European Gastroenterol J 2017;5(6):773-788

14. Lacy B E, Pimentel M et al. ACG Clinical Guideline: management of irritable bowel syndrome. Am J Gastroenterol 2021;116(1):17-44

15. Elli L, Branchi F et al. Diagnosis of gluten related disorders: celiac disease, wheat allergy and non-celiac gluten sensitivity. World J Gastroenterol 2015;21(23):7110-7119

16. Cianferoni A. Wheat allergy: diagnosis and management. J Asthma Allergy 2016;9:13-25

17. Burri E, Beglinger C. Faecal calprotectin – a useful tool in the management of inflammatory bowel disease. Swiss Med Wkly 2012;142:w13557