What is Classical, Non-Classical & Silent Celiac Disease?

March 9, 2024

There are actually three different “types” of celiac disease. They are all equally serious and the main difference is in the symptoms one exerpiences. The three types are classical, non-classical and silent celiac disease. All types are an autoimmune response and cause damage to the villi.

With classical celiac disease, patients show signs and symptoms of malabsorption, such as diarrhea, steatorrhea (pale, foul-smelling fatty stools) and weight loss or growth failure in children.

In non-classical celiac disease, patients may have mild gastrointestinal symptoms without clear signs of malabsorption. Patients may experience abdominal distention and pain. Additional symptoms patients may experience include: chronic fatigue, chronic migraines, iron-deficiency anemia, unexplained elevated liver enzymes, tingling, numbness or pain in hands and feet, reduced bone mass and bone fractures, late menarche, early menopause, unexplained infertility, dental enamel defects, depression, anxiety and dermatitis herpetiformis (itchy skin rash).

Silent celiac disease AKA asymptomatic celiac disease is when patients experience villous atrophy damage to their small intestine, but do not experience symptoms. Most patients do feel better after going on a strict GF diet, including a reduction in acid reflux, bloating and flatulence, despite not experiencing symptoms.

It is important to note that treatment is the same (a strict gluten-free diet), regardless of having classical, non-classical or silent celiac disease. Classical, non-classical and silent celiac disease are all serious and all have villous atrophy damage to their small intestine, despite experiencing symptoms or not.

Unfortunately, it is currently estimated that 80% of the celiac disease population remains undiagnosed due to the number of ways celiac disease can affect patients in addition to a lack of training in medical schools and primary care residency programs. First-degree relatives should always be screened, as there is a 1 in 10 risk of developing celiac disease. Second-degree relatives also have an increased risk of developing celiac disease.

Sources

Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders D, Cellier C, Mulder CJ, Lundin KAE. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. 2019. Doi: 10.1177/2050640619844125