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01 September 2003

Diversity of clinical pictures of celiac disease in adults

Małgorzata Zwolińska-Wcisło, Agnieszka Piàtek, Lucyna Rudnicka-Sosin, Józef Bogdał

Case Rep Clin Pract Rev 2003; 4(2):128-133 :: ID: 429050

Abstract

Background: Celiac disease is a malabsorptive disorder of small intestine, caused by exposure to dietary gluten in genetically susceptible individuals. Its diagnosis is based on the histological investigation of small intestine mucosa, presenting villous atrophy. It is rather easily recognized in children with typical clinical symptoms in majority of cases. In adults clinical features of malabsorptive syndrome are observed only in 30–40% of celiac disease cases. The rest of patients present a broad range of symptoms apparently not associated with digestive tract. The prevalence of celiac disease appears to be much higher than found in clinically apparent cases. Early diagnosis of celiac disease and its treatment with gluten free diet decreases the risk of many complications, such as lymphoma or adenocarcinoma of small intestine, dysmenorrhoe and osteoporosis. Case Report: To show various clinical course of celiac disease and some diagnostic difficulties influencing the delay in proper management of that disease, we present four patients admitted to the Dept. of Gastroenterology of University Hospital in Cracow. In order to diagnose celiac disease, history of disease, blood tests (including the titres of antitransglutaminase autoantibodies– IgA TTA) and imaging procedures were performed. Conclusions: Owing to frequent atypical symptoms, detection of celiac disease in adults is sometimes difficult. It should be taken into the consideration in the differential diagnosis of chronic diarrhea in adults, also in cases apparently not associated with digestive tract, such as persistent bone pains associated with weight loss and iron deficiency in the blood. Evaluation of IgA TTA titre in the blood is useful in screening and follow up of patients with celiac disease. According to IgA deficit observed in some celiac patients (IgA absence in the serum), histopathological evaluation of distal part duodenal mucosa biopsy is the gold standard of detection of celiac disease. Introduction of gluten free diet resulted in regression of clinical symptoms, improvement of blood tests. Decrease of IgA TTA titres in some patients was also observed.

Keywords: heterotopic ossification, Heterotopic bone formation, Myositis Ossificans

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923