Many people assume celiac disease is pretty straightforward: If you eat gluten, you have digestive problems. However, celiac isn’t that simple. It’s a complex autoimmune condition, with several different types. Each type also has its own symptoms—and some of them may surprise you.
Allen Yudovich, M.D., a gastroenterologist at Henry Ford Health, explains the different types of celiac disease, their symptoms and how doctors diagnose them.
What Are the Types of Celiac Disease?
All types of celiac disease have one thing in common: They can damage your small intestine. “Celiac disease requires ongoing medical care, regardless of the type,” says Dr. Yudovich. “Without a strict gluten-free diet, your immune system attacks and damages the cells in your small intestine.”
Over time, this intestinal damage can lead to other health issues and increase your risk for certain digestive cancers. Fortunately, the right diet and regular checkups with your provider will help you stay healthy.
The types of celiac disease include:
Classical celiac disease
Classical celiac is the most common and well-known type. “Classical celiac disease causes chronic diarrhea, which is the most common symptom of celiac,” says Dr. Yudovich. “You might also have unintended weight loss, abdominal pain or bloating.”
Although classical celiac might seem like it’s easy to spot, many people with this type go undiagnosed. “Some people assume they don’t have celiac because they think the diarrhea has to be severe,” says Dr. Yudovich. “But classical celiac symptoms can be mild. The symptoms can also look like other conditions, like irritable bowel syndrome.”
Non-classical celiac disease
Symptoms of non-classical celiac disease can be tricky. “There are up to 250 known symptoms of non-classical celiac disease,” says Dr. Yudovich. “Celiac disease is an autoimmune condition, so it can affect any system in your body.”
Non-classical celiac symptoms may include:
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- Anemia (low number of red blood cells)
- Anxiety, depression or mood changes
- Arthritis and joint pain
- Brain fog or fatigue
- Dermatitis herpetiformis (itchy, blister-like rash)
- Epilepsy or seizures
- Headaches or migraines
- Infertility, miscarriages or other reproductive health issues
- Numbness or tingling in the hands or feet
- Osteoporosis or osteopenia (low bone density)
Silent celiac disease
If you have silent celiac disease, also called asymptomatic celiac disease, you won’t see or feel any symptoms. “Silent celiac disease is difficult to spot because the person feels fine,” says Dr. Yudovich. “Because celiac disease can run in families, doctors may screen you if you have a first-degree relative with the condition. This is often how we find asymptomatic celiac disease.”
If you’re diagnosed with asymptomatic celiac disease, it’s still important to stick to your gluten-free diet. “Silent celiac causes intestinal damage, even if you don’t feel it,” says Dr. Yudovich. “And this type usually doesn’t stay silent forever. Without treatment, many people with asymptomatic celiac disease will experience symptoms or related health issues later.”
Some cases of silent celiac disease aren’t as “silent” as the person initially thought. “Many patients think they’re asymptomatic, but feel much better after adopting a gluten-free diet,” explains Dr. Yudovich. “They realize they simply got used to low-level symptoms or didn’t know that celiac disease was the reason they felt unwell.”
Refractory celiac disease
This rare type of celiac disease doesn’t get better with a strict gluten-free diet. “Only about 1% to 2% of people with celiac disease have the refractory type,” says Dr. Yudovich. “People with refractory celiac may need a special liquid diet and medications to manage the condition.”
Your doctor may diagnose refractory celiac disease if you still have visible intestinal damage after six to 12 months of avoiding gluten. “With the other celiac types, we see a significant improvement in the small intestine after six months,” says Dr. Yudovich.
How Do Doctors Diagnose Celiac Disease?
With so many possible symptoms, how do you know if you have celiac disease or something else? Doctors use a blood test, known as the tissue transglutaminase IgA (tTG-IgA) test.
“The tTG-IgA test looks for antibodies that a person with celiac creates when they eat gluten,” says Dr. Yudovich. “So don’t stop eating gluten before getting the test, or you might receive a false negative result.”
If your blood test is negative, Dr. Yudovich says it’s highly unlikely that you have celiac. “A negative tTG-IgA test usually means we can rule out celiac and look for other issues that might be causing your symptoms,” he says. “If the test is positive, we typically recommend a small intestine biopsy.”
We obtain the biopsy during an upper endoscopy procedure,” says Dr. Yudovich. “A laxative preparation is not required, and the procedure usually takes less than 15 minutes.”
Why A Correct Celiac Diagnosis Matters
If you feel unwell after eating gluten, you might be tempted to just go gluten-free and skip the doctor's visit. However, Dr. Yudovich says that’s not a good idea.
“A blood test and sometimes a biopsy are the only ways to confirm a celiac diagnosis,” says Dr. Yudovich. “Your symptoms might look like celiac, but you could have gluten intolerance.”
Gluten intolerance, or non-celiac gluten sensitivity, causes celiac-like symptoms but doesn’t damage your intestines. “Gluten intolerance is a digestive issue, not an autoimmune disease,” says Dr. Yudovich. “Celiac disease requires follow-up care to check for other health problems, while gluten intolerance does not. That’s why a diagnosis is important.”
Your doctor may diagnose you with gluten intolerance if you have symptoms after eating gluten but your celiac blood test is negative. “We diagnose gluten sensitivity by ruling out other conditions,” says Dr. Yudovich.
Should You Go Gluten-Free?
Avoid gluten only if a doctor has advised you to do so. “If you don’t have celiac disease or gluten sensitivity, there are no benefits to going gluten-free,” says Dr. Yudovich. “But if you have any concerns about your diet or health, contact your healthcare provider. We’re here to help.”
Reviewed by Allen Yudovich, M.D., a board-certified gastroenterologist who sees patients at Henry Ford Medical Center in Royal Oak.
