Silent Celiac Disease

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Melinda Dennis MS, RDN, LDN

Q: What is silent celiac disease?

Answer


In 2013 a multidisciplinary task force of 16 physicians from seven countries published an article evaluating the numerous celiac disease (CD) related terms that exist in the literature.  The team determined that “silent CD” is equivalent to “asymptomatic CD.”  Use of the term silent CD is now discouraged.1

So, let’s take a look at asymptomatic CD.

“Individuals with asymptomatic CD do not manifest any symptoms commonly associated with CD and have no symptoms that respond to gluten withdrawal, even in response to direct questioning.  These patients are often diagnosed through testing of populations enrolled in screening programs or in case-finding strategies for detecting CD in patients with disorders that are associated with a high risk for CD,”1 such as type 1 diabetes and thyroid disease.

There’s another similar term – subclinical CD. Subclinical CD has often been used interchangeably with silent CD and its definition has changed over time.

The task force specified subclinical CD to be” disease that is below the threshold of clinical detection without signs or symptoms sufficient to trigger CD testing in routine practice.  These patients may have clinical or laboratory signs (iron deficiency anemia, abnormalities in liver function tests, [dental] enamel defects, incidental endoscopic features, osteoporosis, etc.) but no symptoms.”1  The main difference I can see between asymptomatic CD and subclinical CD is that patients with subclinical CD may often recognize minor symptoms, such as fatigue only after starting on a gluten-free diet.2

Celiac disease exists along a continuum from very mild to severe.  Patients with asymptomatic CD or subclinical CD are generally identified due to a gastroenterologist’s increased awareness of CD during an endoscopy performed for other reasons or incidental testing of celiac serology (blood work) . These patients will usually display the characteristic damage to the lining of the small intestine without the classic clinical symptoms.2

References

  1. Ludvigsson JF, Leffler DA, Bai J, et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013 Jan; 62(1): 43–52. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440559
  2. Schuppan D, Dieterich W. Up to Date. Pathogenesis, epidemiology, and clinical manifestations of celiac disease in adults. Nov 28, 2018. Accessed April 25, 2019.

Note: This information is provided by NCA and Melinda Dennis, NCA's Senior Consulting Dietitian. This information is meant for educational purposes and is not intended to substitute for personalized medical advice or replace any medical advice provided directly to you by your health care provider. This information can be printed and used in consultation with your physician or dietitian. No liability is assumed by NCA, Ms. Dennis or her nutrition consulting service Delete the Wheat, LLC. by providing this information.

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About Melinda Dennis MS, RDN, LDN

Melinda Dennis, Senior Nutrition Consultant for NCA, is an expert celiac dietitian and and Nutrition Coordinator for the Celiac Center at Beth Israel Deaconess Medical Center in Boston, MA. Diagnosed with celiac disease in 1990, she specializes in the nutritional treatment of patients with celiac disease and gluten-related disorders.

Melinda lectures internationally and has written extensively on the nutritional management of celiac disease including the award-winning book Real Life with Celiac Disease. Melinda was the original founder of NCA in 1993 and so it is only fitting that she comes back to us in this capacity. We are truly honored to have her on our team.