Clinical picture (symptoms and signs)
The disease may present at any age., but peaks in adults at 20-40 years and may occur in infancy after weaning.
Symptoms are those of small bowel disease with malabsorption. There is diarrhea or steatorrhea, abdominal pain, weight loss and nutritional deficiencies. There may be evidence of anemia and malnutrition.
There is an increased incidence of autoimmune disease including thyroid disease and insulin dependent diabetes as well as inflammatory bowel disease, chronic liver disease and fibrosing alveolitis.
Diagnosis
See malabsorption
Jujenal biopsy may reveal subtotal villous atrophy. Endomysial antibodies (IgA) is the investigation of choice since it has more sensitivity and specificity than the anti-Gliadin antibodies (IgA, IgG). IgA and IgG anti-Gliadin antibodies may be associated with false negative and false positive results. False-positives are possible as other gastrointestinal disorders are known to induce circulating antigliadin antibody, mainly Crohn disease, food protein intolerance, and postinfection malabsorption.
Treatment
A gluten free diet usually produces rapid clinical and morphological improvement. Replacement therapy (dietary deficiency) may be required. Corticosteroids and immunosuppression with cyclosporin for cases showing resistance to gluten free diet.
