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Celiac Disease

Ms. T. M. is a 19 year old girl who came in for complaints of weakness, weight loss of about 20 pounds gradually over the past 3 years.  She has also noted a slightly increased frequency of passing stools which are loose.  She also gets abdominal distention and discomfort after meals.  Her maternal aunt has 'sensitivity to wheat' .  On testing her blood, she had severe anemia with a hemoglobin of just 7.  she had very low iron levels.  An upper endoscopy(EGD) was performed which revealed 'scalloped' duodenal folds.  Biopsies were taken and the adjoining picture represents what was seen on microscopic examination of the biopsy specimen.  Blood testing also revealed a high titer of an antibody called tissue transglutaminase antibody.  This confirms the diagnosis of celiac disease which is very common especially in people of Northern European ancestry.  This condition arises from an allergy to wheat protein and leads to inflammation and detruction of the small intestinal lining which then causes malapsorption of ingested nutrients esopecially iron and also some vitamins like vitamin B12.  This then causes a drop in hemoglobin which produces the complaints of weakness.  Since we currently do not have medical treatments for this condition, the management revolves around dietary therapy and stopping all consumption of wheat products.  This condition is hereditary so all first degree relatives of the patient should also be tsted for 'Latent' Celiac disease.  Untreated, this condition can cause severe malnutrition and can also predispose to cancer of the small intestine.  This patient has made a complete recovery after folowing a strict 'Gluten free' diet.

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