*from Greek κοιλιακοc 'abdominal cavity'
Definition: inflammatory disorder of small intestine
caused by prolamins (gliadins—wheat, hordeins—barley,
0-5aet. or 50-60aet. M<F (difference is small). 1/3 asymptomatic.
Highest prevalence in West of Ireland (1:300). Does not
affect native Africans, Chinese, Japanese, &c.
HLA B8, DR3, DQw2. Concordance between MZ twins is 70%.
Dermatitis herpetiformis. Adenovirus 12? (protein E1b
cross reacts with α-gliadin antibodies)
- Fe-deficiency anaemia (malabsorption)
- Abd pain, bloating
- aphthous ulcers, angular stomatitis
- weight↓ (or, failure to thrive in children)
Subtotal subvillous atrophy. Infiltration by plasma cells, mast cells,
lymphocytes, neutrophils, eosinophils.
Biopsy at duodenojejunal junction with Crosby capsule or endoscope.
- FBC, B12, folate.
- U&E (↓K+ from diarrhoea)
- Nutritional status:
Vit. A D E K (β-carotene Ca++ ALP INR)
- Antiendomysial antibodies 95% +ve pred val.
Also anti-reticulin, anti-α-gliadin.
- faecal fat estimation
- Malignancy: T-cell lymphoma (jejunoileitis), oesophageal.
- Hyposplenism (splenic atrophy)
Humoral: circulating IgA and IgG anti-gliadin.
Cell-mediated: Intraepithelial cytotoxic T-cells.
- Diabetes type 1
- Auto-immune thyroid disease
- Addison's disease
Life-long gluten free diet. (Check compliance with α-gliadin antibodies.)
Should see response (symtomatic & histological) in 1–2 weeks. If not gluten challenge and
Collagenous sprue, lymphoma.
Other causes of subtotal villous atrophy: cow's milk intolerance,
soya bean protein intolerance, acute infective gastroenteritis,
giardiasis, eosinophilic gastroenteritis, malignancy, CMV.