In more recent years, there have been changes in the symptoms which patients report when they seek consultation. The severity of the disease generally correlates with the length of the small intestine which has been affected and the severity of the damage which has occurred. When most or all of the small intestinal mucosa is involved, the symptoms are severe and there is general malabsorption present. When that occurs, overt gastrointestinal symptoms and steatorrhea may be absent. Because of the protean ways in which celiac sprue presents, the diagnosis is frequently missed or delayed, particularly in adults.
Many patients experience the onset of symptoms in adulthood.
This may represent primary celiac sprue or may be the unmasking of latent disease. The proportion of those who actually exhibit gastrointestinal symptoms compared to the total number of gluten-sensitized people is not known. Bone pain may be the presenting symptom of patients who have calcium and vitamin D malabsorption and subsequent osteogenic bone disease. Patients who have hypomagnesemia and hypocalcemia can present with tetany. A deficiency may show symptoms of night blindness.