COELIAC DISEASE (COELIAC SPRUE)
Characterised by malabsorption of a variety of nutrients due to villous atrophy of the small intestines, and improvement following withdrawal of dietery gluten, a protein component of several grains.
- Weight loss (patients often hyperphagic), flatulance, greasy foul smelling stools, with anemia, bruising due to vitamin K deficiency, hyperkeratosis due to vitamin A deficiency, and bone pains due to osteomalacia.
- Positive tests of malabsorption with increased faecal fat of over 7 Gm daily with positive sudan test. Demonstration of antigliadin, and antiendomysial antibodies are useful noninvasive tests.
- Diagnosis confirmed by mucosal biopsy of duodenum or proximal jeunum. Barium meal follow- through reveals loss of mucosal folds and fragmentation of the meal within the intestinal lumen. lgG and lgA antibodies are present in serum and may be used for assessing dietary compliance of patient.
Prognosis: Good with adherence to gluten-free diet. Rapid improvement occurs within a few days of treatment.
