Marina was 27 years old when she realized something wasn't right. It wasn't just a "weak stomach." It was bloating after almost every meal, bathroom visits that changed pattern for no apparent reason, a fatigue that sleep couldn't resolve. She spent months thinking it was work stress, until she decided to seek medical help and discovered that she was living with an inflammatory bowel disease. Stories like Marina's are quite common, and that's why it's worth knowing the signs that the body usually gives before diagnosis.

"The data and clinical case mentioned in this article are fictional and are for illustrative purposes only, serving to facilitate understanding of the topic addressed."

What are these two diseases, anyway

Celiac disease and Crohn's disease are different conditions, but sometimes confused because they affect the intestine and cause similar symptoms at the beginning.

Celiac disease is an immune system reaction to gluten, a protein found in wheat, rye, and barley. When a person with celiac disease eats gluten, the body itself attacks the lining of the small intestine, which interferes with nutrient absorption.

Crohn's disease, on the other hand, is a type of inflammatory bowel disease in which the immune system causes chronic inflammation in any part of the digestive tract, from the mouth to the anus, being more common at the end of the small intestine and the beginning of the large intestine.

The first signs of celiac disease

Symptoms vary greatly from person to person, which makes diagnosis take longer. The most common ones include:

  • frequent diarrhea or, conversely, constipation
  • bloating and gas after meals
  • recurrent abdominal pain or discomfort
  • persistent fatigue, even sleeping well
  • unexplained weight loss
  • anemia due to iron deficiency that doesn't improve with supplementation
  • recurrent mouth sores
  • in children, difficulty growing and gaining weight

It's worth noting that some adults don't feel any obvious digestive symptoms. Sometimes the first sign is an itchy skin rash (called dermatitis herpetiformis), infertility without apparent cause, or early osteoporosis.

The first signs of Crohn's disease

Here symptoms tend to be more persistent and often include:

  • abdominal pain, often on the right side, in the lower belly
  • diarrhea that may be accompanied by blood or mucus
  • recurrent low-grade fever
  • unintentional weight loss
  • fatigue that interferes with daily activities
  • mouth sores
  • fissures or fistulas around the anus

Crohn's disease can also manifest outside the intestine, with joint pain, inflammation in the eyes, or skin lesions.

When do these symptoms stop being "just a sensitivity" and deserve investigation

Isolated and temporary digestive symptoms happen to everyone. What calls attention for more careful investigation is the combination of:

  • symptoms that persist for more than two or three weeks
  • blood in the stool, even in small amounts
  • weight loss without being on a diet
  • fatigue that doesn't improve with rest
  • symptoms that interrupt sleep at night
  • family history of celiac disease, Crohn's, or another autoimmune disease

None of these signs, in isolation, means that the person has one of these diseases. They only indicate that it's worth talking to a doctor to investigate the cause.

What the path to diagnosis usually looks like

The first step is always a consultation with a general practitioner or gastroenterologist, who will listen to the symptom history and examine the person. From there, the most commonly used tests are:

  • blood tests, including specific antibodies that help screen for celiac disease
  • upper digestive endoscopy with biopsy of the small intestine, to confirm celiac disease
  • colonoscopy with biopsies and, in some cases, imaging tests of the small intestine, to investigate Crohn's
  • fecal calprotectin test, which helps identify intestinal inflammation

It is important not to stop eating gluten on your own before investigating celiac disease, because this can alter the test results and delay correct diagnosis.

Recognizing these signs early is not a reason for alarm, it's a reason to inform yourself and seek evaluation. Many people live well with these conditions after they receive the correct diagnosis and appropriate treatment.

This content is educational in nature and does not replace a medical consultation. Each person is unique, and the diagnosis and treatment of these conditions should be done by a healthcare professional, based on individual evaluation.

Dr. Rebeca Soares Andrade CRM - GO 39335