Coeliac disease is a condition in which patients have an immune reaction to eating gluten. Gluten is a protein found in certain foods containing wheat, barley, or rye. While most people with the condition develop digestive symptoms like bloating, diarrhoea, abdominal pain, and weight loss, there are some who live for years without any noticeable gut-related discomfort. This is called silent coeliac disease.
But while there are no symptoms, undiagnosed and untreated coeliac disease can cause long-term problems. So how can someone have coeliac disease without knowing it, and what can be done to detect it early? We spoke to Dr Bhumesh Tyagi, Consultant – General Medicine and Physician, Shardacare – Health City, Greater Noida, to understand what makes this form of coeliac difficult to detect and why early screening is key.
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What Exactly Is Silent Coeliac Disease?
Silent coeliac disease is a form of coeliac disease that goes unnoticed for years because it doesn’t cause the noticeable digestive symptoms. Despite the absence of these symptoms, people with silent coeliac still suffer the same internal intestinal damage.
Gluten, a protein found in wheat, barley, and rye, triggers an immune reaction in genetically predisposed individuals. This response leads to inflammation and damage to the lining of the small intestine, particularly the villi, which are responsible for absorbing nutrients.
Usually, the damage becomes obvious through noticeable symptoms, prompting testing and diagnosis. But in the silent form, people may feel perfectly fine or experience vague, non-gastrointestinal issues like fatigue, joint pain, or mild anaemia, which they often attribute to stress, ageing, or other factors.
According to research published in the Turkish Journal of Gastroenterology, for every diagnosed case, there may be five undiagnosed ones, many of which are silent. This hidden burden is often described as the ‘coeliac iceberg, with the majority of cases remaining hidden. Research in schoolchildren has shown that the silent form is more common than the classic type.
For instance, a study in Turkey found that out of eight diagnosed children, five had silent coeliac. Left untreated, even asymptomatic cases can lead to serious health issues like osteoporosis, infertility, and autoimmune conditions. This highlights the importance of screening and raising awareness, particularly in high-risk groups.
Long-Term Risks To Note, If Left Undiagnosed And Untreated
Just because there aren't symptoms doesn’t mean it’s harmless. The long-term health consequences of untreated coeliac can be serious, even if it is silent. “People with undiagnosed silent coeliac continue to experience immune-mediated damage and nutrient malabsorption,” says Dr Tyagi. Over time, this can lead to multiple complications, such as:
- Osteoporosis, due to calcium and vitamin D malabsorption
- Iron-deficiency anaemia, which may go unnoticed
- Infertility and pregnancy complications
- Increased risk of certain cancers, especially gastrointestinal cancers and lymphomas
- Neurological issues, including balance problems, peripheral neuropathy, and migraines
- Cardiovascular problems, likely related to chronic inflammation
- Delayed growth or puberty in children
Moreover, untreated coeliac disease can also be associated with other autoimmune disorders, including Type 1 diabetes and thyroid disease. The hidden damage can affect one’s educational or occupational performance due to chronic fatigue, mental fog, or mood changes, even if the person appears healthy on the outside.
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With No Symptoms, How Can People With Silent Coeliac Be Diagnosed?
Dr Tyagi points out that first-degree relatives (parents, siblings, children) have a significantly higher risk—around 5–10% compared to the general population. In fact, studies suggest that nearly 24% of asymptomatic siblings may have silent coeliac.
Diagnosis usually begins with blood tests, particularly serologic markers like tissue transglutaminase IgA (tTG-IgA), endomysial antibody (EMA-IgA), and deamidated gliadin peptide antibodies (DGP-IgA or IgG). If these tests return positive, a small intestinal (duodenal) biopsy is done to confirm the presence of villous atrophy, the hallmark of coeliac disease. For those already on a gluten-free diet or with inconclusive results, genetic testing (HLA-DQ2/DQ8) and a supervised gluten challenge may help establish the diagnosis.
Routine testing every 1–3 years for at-risk individuals is also advised, especially in children, since coeliac disease can develop over time.
Conclusion
Silent coeliac disease isn’t just a milder version of the condition; it’s a hidden threat that can quietly harm your body over time. Just because you don’t feel any stomach issues doesn’t mean everything is fine on the inside. Without knowing it, many people live with ongoing intestinal damage, which can lead to serious health problems later on. That’s why regular screening is so important, especially if you have a family history or unexplained issues like tiredness, low iron, or joint pain. It is best to consult a doctor, especially if any of your immediate family members are diagnosed with gluten intolerance.