Atlas of gastroenterological Endoscopy
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Celiac disease - common sprue
Sprue Sprue
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.
Celiac disease without mucosal changes
prior to therapy after therapy
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. 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.