Coeliac disease has symptoms that range from gastrointestinal to neurological to dermatological and beyond. While many individuals who are diagnosed exhibit symptoms, not everyone does. These individuals go about their lives without anything feeling wrong. That, however, does not mean that gluten is not causing problems.
Asymptomatic coeliac disease is an individual that, despite positive antibodies, despite the damage in the small intestine as showed by endoscopy, you will not experience any signs or symptoms.
The question arises, why do some people present as highly symptomatic and some without any signs at all? Presently, this is not yet understood. There is still a lack of understanding why some people, despite the inflammation there, they don’t have symptoms. The general wisdom that probably will be correct is that the [small] intestine is a long tube in an adult, it’s an average of 20 feet long, and when we do the endoscopy, we look at only the first few inches. So it’s intuitive that if your damage is only at the very beginning and the rest of the intestine is spared, you may be more in the asymptomatic group.
When it comes to asymptomatic coeliac disease, the true absence of symptoms can be put into question because everyone has a different perspective on how they feel. Due to this, It’s hard to say, because the definition of symptoms or lack of symptoms, it’s a threshold that is very subjective, and people have a different way to perceive if they’re healthy or not.
Some patients diagnosed as asymptomatic will feel differently after they begin the gluten-free diet. They come back and say ‘Oh boy, I didn’t realise I was so tired. I thought because I had kids to deal with and I wake up at 6 o’clock in the morning and this was the source of their fatigue. Other patients have said, You know, that extra gas, I thought everybody had this kind of gas. Now I feel less bloated and less gas, less stomachache and so on and so forth.
The reality is that it’s very, very difficult, particularly when we talk about subjective symptoms, to establish who is truly asymptomatic. We are aware about that because of this screening in family members that are higher risk with coeliac disease, which leads to the diagnosis of a family member. Since coeliac runs in families, it’s important for family members to be tested. When it comes to screening for coeliac, the top priority would be first-degree relatives,.