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Celiac Disease Clinical Presentations

The clinical presentation of celiac disease varies greatly, ranging from asymptomatic to severely malnurished patients. The most common clinical manifestations of celiac disease include abdominal cramping pain with moderate to severe abdominal distension, frequently associated with relapsing or permanent dyspepsia, presence of gastro-esophageal reflux ( GERD ) and recurrent episodes of altered bowel habits (diarrhea and/or constipation), weight loss, bone disease, anemia and weakness.

While diarrhea was almost considered a persistent symptom, this is not the case in adults, and up to 50% of patients predominantly have constipation, which on many occasions becomes refractory to all types of therapy. It should be noted, that up to 30% of celiac patients have increased body mass index (BMI) and obvious obesity at diagnosis.

Celiac disease is sometimes divided into clinical subtypes. The terms “symptomatic or classic” apply to cases that meet the typical features described above. By contrast, in the “atypical forms” of the disease, the gastrointestinal symptoms may be absent or less pronounced, and in this case the extra-intestinal features predominate, such as chronic iron defi ciency anemia, osteoporosis, short stature or failure to thrive, infertility and increased number of abortions.

Since atypical presentations are found more frequently in later decades, celiac disease is now considered to be a multisystemic disorder, rather than a sole gastrointestinal process .

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