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Intestine & digestion

Celiac disease, what are the extra-intestinal symptoms?

January 1, 2018


One of the most known diseases of the gastrointestinal system, celiac disease, can also be reported by symptoms that do not directly relate to the intestine. These are so-called extra-intestinal symptoms. We talk about this topic with Dr. Paoletta Preatoni, gastroenterologist and digestive endoscopist at Humanitas.



Celiac disease

About 1% of the Italian population is affected by celiac disease, mainly women, with a proportion of two to one compared to men. Celiac disease is an inflammatory disease of the small intestine caused by gluten ingestion. In genetically predisposed subjects, the intake of this protein, contained in various cereals including wheat, rye and barley, is caused by damage to the intestinal mucosa characterized, in particular, by the atrophy of intestinal villi. For this reason, the only therapy for the treatment of this disease is adherence to a diet with gluten-free foods.


A suspicion of celiac disease may arise when certain symptoms such as alteration of intestinal regularity, diarrhea or constipation, loss or gain of weight, meteorism, swelling and abdominal pain occur. These symptoms, a-specific or common to other diseases or conditions such as irritable bowel syndrome or lactose intolerance, directly affect the gastrointestinal system. Other symptoms, of a different nature, may also be present: “Celiac disease has a spectrum of manifestations that vary from individual to individual, both in terms of gastrointestinal symptoms and in terms of extra-intestinal manifestations,” recalls Dr. Preatoni.


These can range from asthenia to early fatigue, headache, infertility in women, multiple abortions, fragile nails and hair and osteoporosis. All these symptoms or clinical signs – continues the specialist – are linked to selective or generalized malabsorption of nutritious substances (iron, calcium, cholesterol) typical of celiac disease “.


Gastrointestinal symptomatology may be completely absent or non-specific (abdominal swelling, difficult digestion, etc.) in celiac patients while one or more of the above mentioned symptoms or laboratory alterations such as anemia, sideropenia, hypocholesterolemia etc. may be present.

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Tests and examinations for diagnosis

Intestinal or extra-intestinal symptoms are a-specific and may be associated with other diseases: The spectrum of clinical manifestations of celiac disease can be common both with regard to intestinal and extra-intestinal symptoms to other diseases for which it is always important, in the presence of a single symptom or laboratory alteration, to carry out a specialist evaluation that allows an early and correct diagnosis in order to avoid the possible consequences of a diagnostic delay “, concludes the specialist.


The specialist doctor may define a diagnosis of celiac disease based on the results of certain examinations. It will be necessary to undergo blood tests, with serological assay of some antibodies, and a biopsy of the small intestine to detect atrophy of intestinal villi.

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