General Illness Information
Medical Term: Gluten Enteropathy
Description: A chronic diarrheal disease characterized by intestinal malabsorption of almost all nutrients precipitated by eating foods containing gluten.
This intestinal sensitivity to gluten, a protein found in wheat, barley, rye and oats causes changes in the intestine which prevents it from absorbing nutrients.
Usually present between ages of 6-12 months when the child is first introduced to gluten. However, in adults symptoms may develop slowly over months or years.
Most forms of the disease are inherited and it is not contagious.
Causes: Usually a congenital disorder with sensitivity to gluten, a protein found in wheat and rye and to a lesser degree in oats and barely.
In this condition, the gladding fraction of the gluten molecule attaches to the antibodies in the small intestine, causing the normal brush-like lining of the intestine to flatten. These changes reduce the digesting and absorbing capability of the small intestine. However, when gluten is eliminated from the diet, the normal brush-like surface is restored and normal intestinal function is restored.
Prevention: Unknown at present.
Signs & Symptoms
- Weight loss in an infant after the introduction of cereal.
- Failure to thrive in an infant
- Poor appetite.
- Diarrhea with pale, bulky, greasy, foul smelling stools. Diarrhea may be absent in 10% of cases.
- Swollen abdomen.
- General undernourished appearance.
- Swollen legs.
- Family history. First order relatives -10% incidence; 71% in monozygotic twins
- Children with type I diabetes mellitus.
- IgA deficiency.
- Down’s Syndrome.
Diagnosis & Treatment
Laboratory tests includes blood tests, stool test for fecal fat, d-xylose test for malabsorption and small bowel biopsy. .In celiac disease, the blood test is positive for Anti-gliadin IgA and IgG and anti-reticulum and anti-endomycial antibodies.
- Firm diagnosis is made by a biopsy, in which a small sample of tissue is taken from the small intestine.
- Only treatment is a gluten-free diet. Rice, corn and soybean flour are good substitutes. Gluten is present in most grains especially wheat, rye and barley.
- Iron and folic acid for anemia.
- Calcium and multiple-vitamin supplements for deficiencies.
- Oral cortisone may hasten improvement but is only in very severe attacks (undecided).
Gluten-free diet. It is difficult to exclude gluten from the diet completely, so be patient while becoming familiar with the diet, which a dietitian can help you plan.
With a strict gluten-free diet improvement occurs in 2-3 weeks. In rare cases, gluten withdrawal does not bring immediate improvement. These patients may respond to treatment with corticosteroids.
A small percentage of adult patients with celiac disease may develop a lymphoma in the intestine. It is not known if adhering to a strict gluten-free diet diminishes the risk of developing a lymphoma.