- Abnormal jejunal mucosa due to intestinal reaction to alpha-gliadin antigen in gluten (found in barley, rye, oats and wheat)
- Associated with other autoimmune diseases
- Women > men; family history; peaks in infancy and old age
Presentation
- Malabsorption: diarrhea, weight loss, anemia, symptoms of vitamin/mineral deficiency (most severe in proximal bowel affecting Fe, Ca and folic acid)
- Improves with gluten-free diet
- May be associated with dermatitis herpetiformis skin eruption
Investigations
- Small bowel mucosal biopsy (4-5 samples, as disease may be patchy)
- Villous atrophy and crypt hyperplasia
- Infiltration of the lamina propria with chronic inflammatory cells
- Clinical response to gluten-free diet
- Antigliadin antibodies (AGA), Antiendomysial antibodies (EMA), Tissue transglutaminase antibodies (tTG)
- Levels of ferritin/Fe saturation, Ca, Fe, albumin, cholesterol, carotene, B12 – assess for malabsorption
Treatment
- Gluten free diet – no barley, rye, oats, wheat
- If symptoms continue consider:
- Erroneous diagnosis
- Gluten ingestion
- Cow milk, soy, “food” sensitivity
- Intestinal lymphoma
- Concurrent disease (pancreatic insufficiency)
- Lactase deficiency