-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