| Celiac disease - common sprue |
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This 60 year old patient presented with a history of diarrhea over several years with recent weight loss (12 kg)
for several months. Malabsorption was evident from serologic testing. The patient showed vitamine B12-hypovitaminosis,
hypocalcemia, hypoproteinema and a deficiency in folic acid. Makroscopically a rough mucosal pattern is seen in the
pictures, in severe cases mucosal atrophy may develop.
The diagnostic test of choice is histology (minimal 5-7 biopsies), which will show villous atrophy, crypt hyperplasia
and lymphocytic infiltration. Immunologic testing (endomysium-AB, gliadine- AB, reticulin-Ab,and most recently with
the highest specifity AB against tissue glutaminase) prooves the diagnosis and will give valuable information on
disease activity during treatment.
Therapeutically a glutene- free diet is indicated and might be used diagnostically in cases of inconclusive diagnosis.
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| Celiac disease without mucosal changes |
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After 6 months treatment with a gluten-free diet
the mucosa shows a normal appearance. The diarrhea subsides,
the patient gains 5 kg in weight. In case of the above
discribed symptoms a duodenal biopsy has to be performed
even in a normal duodenal mucosa.
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Young patient with weight loss and recurrent
diarrhea. Pancreatic tests and stool cultures
reveal no abnormality. Further labatory work- up
shows slight macrocytic anemia and depressed calcium
levels. Endoscopy only shows a erythematous duodenal
mucosa and intact villi. Histology is able to pro-
duce the diagnosis of celiac disease.
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