Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease

Joseph A. Murray, Tureka Watson, Beverlee Clearman, Frank Mitros

Research output: Contribution to journalArticlepeer-review

184 Scopus citations


Background: Atypical presentations of celiac disease appear to be at least as common as is the classic presentation of steatorrhea, diarrhea, and weight loss. Objective: We examined the effect of a gluten-free diet on gastrointestinal symptoms in a cohort of US patients with celiac disease. Design: A follow-up survey was conducted in 215 patients who were evaluated at the University of Iowa from 1990 through 1997 as having biopsy-confirmed celiac disease. The systematic survey asked detailed questions regarding gastrointestinal symptoms before and after the institution of a gluten-free diet in the patients, all of whom had been given the same dietary advice. Results: The group consisted of 160 female and 55 male patients. Although diarrhea was the most frequent symptom in untreated celiac disease, steatorrhea occurred in only one-fifth of patients. Other complaints were common, and most responded to gluten exclusion. The benefit of gluten exclusion was equally apparent in men and women. Diarrhea responded in most patients, usually within days, and the mean time to resolution was 4 wk. Many patients had alternating diarrhea and constipation, both of which were responsive to the gluten-free diet. Most patients had abdominal pain and bloating, which resolved with the diet. Conclusions: Celiac disease causes a wide range of gastrointestinal symptoms. Clinicians must have a high level of suspicion to detect the atypical forms of celiac disease. With a gluten-free diet, patients have substantial and rapid improvement of symptoms, including symptoms other than the typical ones of diarrhea, steatorrhea, and weight loss.

Original languageEnglish (US)
Pages (from-to)669-673
Number of pages5
JournalAmerican Journal of Clinical Nutrition
Issue number4
StatePublished - Apr 2004


  • Abdominal pain
  • Celiac disease
  • Enteropathy
  • Gluten-free diet
  • Irritable bowel syndrome

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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