-IBIS-1.5.0-
tx
digestive system
celiac disease
diagnoses

definition and etiology

definition:
a chronic malabsorption syndrome caused by an intolerance to gluten; also called "non-tropical sprue" and "gluten-induced enteropathy"

etiology:
Genetic factors, possibly relating to histocompatibility antigens, create an intolerance to gliadin, a component of gluten. Patients must therefore avoid wheat, barley, oats and rye, which are high in gluten. Immune reactions cause villus damage and crypt hypertrophy. The typical change in the small bowel consists of a flattened jejunal mucosa, yet the severity of the symptoms does not correlate with the severity of the intestinal changes.

signs and symptoms

signs and symptoms: may be variously symptomatic or asymptomatic
• typical malabsorption syndrome: weight loss, diarrhea, intestinal distention with bloating, steatorrhea, abnormal results in tests for intestinal absorption
• infancy or adulthood onset (although in adult-onset, most mothers will remember the child having digestive problems as a baby)
• infant presentation: failure to thrive, passes offensive bulky stools, colicky, iron deficiency; edema may develop

lab findings:
• (+) biopsy of the jejunal mucosa
• clinical, biochemical and histological improvement after initiating a low-gluten diet
• iron deficiency in children and folate acid deficiency in adults
• (+) 5 gm. d-Xylose test.
• steatorrhea, 72-hour fecal fat useful
• possibly low serum calcium, albumin, potassium, sodium and increased alkaline phosphatase
• (+) barium studies
• autoantibodies present in some
• decreased cholesterol, triglycerides in blood
• low serum carotene
• PT prolonged
• anemia from iron, B12 and folate deficiency
• decreased BUN from decreased absorption

course and prognosis

The prognosis is good in 80% of patients if they stay on a gluten-free diet, and if the disease was not too severe at the onset (severe cases may be fatal). Most experience remission within a few weeks. Some patients eventually reintroduce small amounts of gluten back into their diets.

Complications include intestinal ulcers, dermatitis herpetiformis and risk for adenocarcinoma and intestinal lymphoma.

differential diagnosis

• ulcerative colitis
• Crohn's disease (regional enteritis)
• tropical sprue
• Whipple's disease
• lactose intolerance
• food intolerances
• pancreatic insufficiency
• malabsorption syndromes
• gastroenteritis


footnotes