gluten-sensitive enteropathy


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gluten-sensitive enteropathy

coeliac disease

A malabsorptive syndrome caused by hypersensitivity of intestinal mucosa to alpha-gliadin, a gluten extract composed of glutamine and proline-rich proteins that is found in wheat, barley, rye, and oats.
 
Clinical findings
Diarrhoea, copious fatty stools, abdominal distension, weight loss, haemorrhage, osteopenia, muscle atrophy, peripheral neuropathy, CNS and spinal cord demyelination (sensory loss, ataxia), amenorrhoea, infertility, oedema, petechiae, dermatitis herpetiformis (especially if HLA B27), alopecia areata. Occult bleeding occurs in half of patients.
 
Lab
Transaminases (ALT, AST) are increased in ± 40% of patients with CD, which usually normalises with a gluten-free diet; iron deficiency, anaemia due to occult bleeding.

Diagnosis
Duodenal biopsy; anti-gliadin and anti-endomysial antibodies.
 
Management
Eliminate gliadin from diet.

Prognosis
Without treatment, 10–15% develop lymphoma (e.g., immunoblastic lymphoma; less commonly, T cell lymphoma), a risk that increases with disease duration. CD predisposes to gastrointestinal lymphoma and carcinoma of the oral cavity and oesophagus; the otherwise rare small intestinal adenocarcinoma is 80-fold more common in CD.
dermatitis herpetiformis chronic skin disease characteristic of coeliac disease, with groups of severe, extensive, pruritic papules, subepidermal blisters and dermal microabscesses on extensor surfaces

disease

pathogenic entity characterized by an identifiable aetiological agent, group of signs and symptoms and/or consistent anatomical alterations; see syndrome
coeliac disease; gluten-sensitive enteropathy autoimmune-mediated, familial, genetic and environmental tendency to small-intestine inflammation due to gluten allergy, characterized by gluten (wheat) intolerance and resultant malabsorption of food; characterized by abdominal pain, chronic diarrhoea, weight loss and mouth ulcers; presents at any age, predominantly affecting females, atopic individuals, those with autoimmune disease (e.g. thyroid disease, type 1 diabetes mellitus, inflammatory bowel disease), chronic liver disease and fibrosing alveolitis; it characteristically causes dermatitis herpetiformis
References in periodicals archive ?
These patients may have a long history of gastrointestinal symptoms which may not have been recognized as being caused by gluten-sensitive enteropathy.
Marsh (5) introduced a grading scheme to classify the morphologic spectrum of gluten-sensitive enteropathy in 1992, based on his clinical research on a variety of small-intestinal disorders and observations of the intestinal response to gluten challenge, reported as a series of studies.
Gluten-sensitive enteropathy in Spain: genetic and environmental factors.
Collagenous enterocolitis: a manifestation of gluten-sensitive enteropathy.
Celiac disease, also known as celiac sprue, nontropical sprue, gluten-induced enteropathy, or gluten-sensitive enteropathy (GSE), is a chronic inflammatory disorder of the small intestine characterized by malabsorption after ingestion of wheat gluten or related proteins in rye (secalins) and barley (hordeins) in individuals with a certain genetic background.
Conditions Included in the Differential Diagnosis of Gluten-Sensitive Enteropathy IELosis Villous Shortening/Flattening HP-associated gastroduodenitis Microvillus inclusion disease Nongluten food hypersensitivity Autoimmune enteropathy Infections (Giardia, Tropical sprue Cryptosporidium, etc) Bacterial overgrowth Refractory sprue Drugs (primarily NSAIDs) Collagenous sprue IgA deficiency Radiochemotherapy Common variable Graft-versus-host disease immunodeficiency Crohn disease Nutritional deficiencies Small-bowel allograft rejection EITCL Abbreviations: EITCL, enteropathy-induced T-cell lymphoma; GSE, gluten-sensitive enteropathy; HP, Helicobacter pylori; IELosis, intraepithelial lymphocytosis; IgA, immunoglobulin A; NSAIDs, nonsteroidal anti-inflammatory drugs.