Gastroenterology
Stephan Strobel, Lewis Spitz, Stephen D. Marks in Great Ormond Street Handbook of Paediatrics, 2019
Symptoms and signs of a ‘classical’ presentation of coeliac disease are anorexia, vomiting, abdominal distension, diarrhoea, irritability, failure to thrive and buttock wasting in a postweaning infant/young child. Other presentations can include constipation, non-specific abdominal pain, recurrent apthous ulceration of the oral mucosa, anaemia, growth failure or even asymptomatic (Figs 9.17, 9.18). Presentation can be at any age throughout life, although roughly 2/3 of cases present in childhood. Autoimmune diseases such as diabetes mellitus and thyroid disease are associated, and it occurs with increased frequency in Down, Turner and Williams syndromes. Coeliac disease should also be considered in epilepsy with intracranial calcification and unexplained neurological conditions, e.g. palsies, neuropathies, migraine. In adults, dermatitis herpetiformis, splenic atrophy and neoplasia (in particular, T-cell lymphoma of the small intestine) may develop.
The Child With Diarrhoea
Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan in Diagnosing and Treating Common Problems in Paediatrics, 2017
The first step is to take a blood test to measure the levels of a certain antibody – anti-tissue transglutaminase – in the blood. The antibody test measures your child’s immune system response to gluten, which is found in common foods such as wheat, rye, barley and oats. The test results will help determine whether a biopsy is needed; however, the test is only a screening test and cannot diagnose coeliac disease. Coeliac disease is a life-long condition; therefore, it is important that we are certain about the diagnosis, and the only way to confirm it is to take a small tissue sample or biopsy of the small intestine. In the meantime, he should continue on his normal diet and should have gluten in at least one meal for a minimum of 6 weeks. The tissue will be examined to see if eating gluten has damaged the surface of the small intestine. To get the tissue sample a gastroscope will be passed into the mouth, down into the small intestines.
Bowel disorders
Henry J. Woodford in Essential Geriatrics, 2022
Coeliac disease typically presents with diarrhoea and weight loss but can also produce symptoms relating to reduced absorption, i.e. iron-deficient anaemia, osteomalacia (increasing the risk of osteoporotic fractures) or folate deficiency (e.g. macrocytic anaemia). Vitamin B12 is absorbed in the terminal ileum and so its absorption is unaffected (seeTable 12.3). Coeliac disease is caused by intolerance to gluten (found in wheat, rye and barley). It is associated with autoimmune disease. If untreated, there is an increased risk of small bowel lymphoma and hyposplenism. It is thought to have a prevalence of 0.5–1% in the general population in Europe and North America.25 As many as 15–19% of cases may be diagnosed in people over age 65.26,27 Endomysial antibody and tissue transglutaminase antibody have high sensitivity and specificity when used in combination.24 Duodenal biopsy can be used for diagnosis if there is a high clinical suspicion despite negative serological tests. Treatment is by the avoidance of gluten in the diet. When this is achieved, improvements are seen in weight and nutrient absorption.
Methotrexate induced peritonitis: diagnosis per exclusionem
Published in Journal of Obstetrics and Gynaecology, 2021
Raphaël Rienstra, Eva A.S. Koster, Catharina C.A.H. Janssen
Gastritis (Helicobacter pylori).Gastric ulcer.Stomach perforation.Cholecystitis.Pancreatitis.Pulmonary embolism.Peritonitis.Pericarditis.Molar metastasis.Coeliac disease.
Risk of vascular diseases in patients with dermatitis herpetiformis and coeliac disease: a long-term cohort study
Published in Annals of Medicine, 2023
Noora Nilsson, Joonas Leivo, Pekka Collin, Inka Koskinen, Katri Kaukinen, Heini Huhtala, Johanna Palmio, Timo Reunala, Kaisa Hervonen, Teea Salmi, Camilla Pasternack
Coeliac disease is a common immune-mediated intestinal disorder driven by dietary gluten in genetically predisposed individuals [1]. Gastrointestinal symptoms, such as diarrhoea and abdominal pain, are considered to be the classic symptoms of coeliac disease, but the disease may also present with a variety of extraintestinal symptoms [1]. Dermatitis herpetiformis (DH), a cutaneous manifestation of coeliac disease, typically presents as a pruritic, blistering, and papular rash [2]. In DH patients, granular immunoglobulin A (IgA) deposits are seen in the papillary dermis and epidermal transglutaminase (TG3) acts as the target autoantigen [3]. In addition, patients with DH also have a coeliac-type systemic disease with circulating antibodies against tissue transglutaminase (TG2) and a varying degree of enteropathy, ranging from minor inflammatory changes to severe villous atrophy in the small bowel mucosa [2]. Regardless of the intestinal findings, DH patients rarely have severe gastrointestinal symptoms [2].
Risk of fractures in dermatitis herpetiformis and coeliac disease: a register-based study
Published in Scandinavian Journal of Gastroenterology, 2019
Camilla Pasternack, Inka Koskinen, Kaisa Hervonen, Katri Kaukinen, Jutta Järvelin, Timo Reunala, Pekka Collin, Heini Huhtala, Ville M Mattila, Teea Salmi
Long term follow-up data were obtained by enrolling all patients diagnosed with DH between the years 1969 and 2000 at the Department of Dermatology at Tampere University Hospital. The department has a special outpatient clinic for patients with DH, where all DH patients within the catchment area of the hospital district are diagnosed. The DH diagnosis of each patient relied on clinical symptoms compatible with DH and demonstration of dermal IgA with direct immunofluorescence examination [17]. The coeliac disease study group comprised all patients in the Tampere area with a small bowel biopsy-based diagnosis made during the same time period as the patients with DH. All patients with a DH diagnosis were excluded from the coeliac disease study group, which thereafter included patients with any other phenotype of coeliac disease than DH. Furthermore, the patients diagnosed with coeliac disease for more than one year prior to a DH diagnosis were excluded from the DH study group. Eventually, our DH study cohort comprised 368 patients, and the coeliac disease cohort 1076 patients.