Symptom Checklists

These have been developed to help identify individuals who should be tested for Celiac Disease.

Could Gluten Be Causing Your Health Problems? new
Guidelines-based screening checklist from Glutenfreeindy and Gluten Intolerance Group

The National Foundation for Celiac Awareness questionnaire

The Kogan Celiac Center questionnaire

What is your Celiac Score?

Five Questions Find Hidden Celiac Disease in Kids

List of Symptoms from Beth Israel Deaconess Celiac Center



GlutenFreeIndy Screening Questionnaire

?Could Gluten Be Causing Your Health Problems?

Fill out this screening questionnaire to find out!

This survey is based solely on the current medical guidelines, which you can access online for further information or to take to your doctor
(see references below).

If you check even one of these items, you are at increased risk for having Celiac Disease, and it would be a good idea to ask your doctor for the screening blood tests.

The treatment for CD is to remove gluten from your diet. However, it is recommended that you not exclude gluten before you are tested as this will lower the chances of getting accurate results.

Questionnaire

Do you have a family history of Celiac Disease or Dermatitis Herpetiformis?

Have you had recurring problems with:

Diarrhea

Constipation

Joint pain

Fatigue

Tingling or numbness in hands or feet

Abdominal pain

Bloating

Loss of appetite

Vomiting

Unintended weight loss

An itchy skin rash occurring on both sides of the body, such as on both elbows or knees

Unexplained infertility or fetal loss

Elevated liver function tests (AST, ALT)

In childhood: poor weight gain or failure to thrive

In childhood: short stature or delayed puberty

Have you been diagnosed with:

Irritable bowel syndrome

Anemia (iron, folic acid or B-12 deficiency)

Arthritis

Migraines

Colitis (microscopic, lymphocytic or collagenous)

Osteoporosis or Osteopenia (low bone density)

Osteomalacia (softening of bones)

Dental enamel defects in permanent teeth

Peripheral neuropathy

Autoimmune thyroid disease (Hashimoto's Thyroiditis or Graves Disease)

Type 1 Diabetes

Sjogren's Syndrome (causes dry eyes and dry mouth)

Liver disease

Addison's disease

IgA Nephropathy

Selective IgA deficiency

Cerebellar ataxia

Epilepsy

Occipital calcifications

Down syndrome

Turner syndrome

Williams syndrome


References:

AGA Institute Medical Position Statement on the Diagnosis and Management of Celiac Disease.
Gastroenterology. 2006 Dec;131(6):1977-80

Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.
J Pediatr Gastroenterol Nutr. 2005 Jan;40(1):1-19

World Gastroenterological Organisation Practice Guideline: Celiac Disease. Paris (France): World Gastroenterological Organisation; 2007, 18 p.

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