As part of this immune reaction antibodies to tTG are produced and are recognised as endomysial antibodies. Clinical features The classic presentation of a patient with abdominal distension, steatorrhoea, weight loss, bruising and other obvious features of malabsorption is now uncommon. Adults are more likely to seek help for milder, non-specific symptoms such as diarrhoea, flatulence and bloating, or fatigue. The clinical features have also changed in children. It can also lead to irritability and poor school performance.
Coeliac disease can also present with non-gastrointestinal problems.
Apart from anaemia, it can cause recurrent mouth ulcers and, in women, delayed menarche, infertility or repeated miscarriage. Most adults with coeliac disease will have significant osteopaenia at the time of presentation. Most of the others have more subtle mucosal changes. Coeliac disease is significantly more common in patients with type 1 diabetes, autoimmune thyroid disease, IgA deficiency and Down's syndrome. The most important factor for the early diagnosis of coeliac disease is a high index of suspicion, keeping in mind the variable clinical features and known associated disorders.