A classical set of celiac disease symptoms no longer reflects the profile of most newly-diagnosed patients, according to a new study from Italy.

Instead, doctors need to take other symptoms into account and consider the possibility of celiac disease, even when patients don’t fit the old image of the condition, researchers say.

“It’s been a gradual phenomenon since the 1970s that fewer people are presenting with the classical diarrhea and more with non-classical or silent presentation, both in adults and children,” said Dr. Peter Green, who wasn’t involved in the study.

“We don’t actually know why one person has diarrhea and another presents with abdominal pain or osteoporosis,” said Green, director of the Celiac Disease Center at Columbia University in New York.

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