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Gluten - Sensitive Enteropathy [Celiac disease)

  1. Gluten sensitive enteropathy is a disorder in which small bowel mucosal damage is the result of a permanent sensitivity to dietary gluten.
  2. The disorder does not present until gluten products have been introduced into the diet
  3. Most common period of presentation is between 6m-2 yr.
  4. Pathogenesis  develop only after long term dietary exposure to the protein gluten which is found in wheat, Rye and Barely. The activity of gluten resides in the gluten results in villus atrophy crept hyperplasia. The injury is greatest in the proximal small bowel and extend distally for a variable. 

Clinical manifestations
 

Symptoms

Sign

Failure to thrive

    Height < 251h percentile

Diarrhea

    Body weight < 25th percentile

Irritability

    Wasted Muscles

Vomiting

    Abdominal distension

Anorexia

    Edema

Foul stool

    Finger clubbing

Abdominal pain

Excessive appetite

Rectal prolapse

 

 

An increased prevalence of gluten sensitive enteropathy has been noted in children with selective IgA deficiency diabetes mellitus, chronic rheumatoid arthritis and Down syndrome

 

Investigation

  1. → Sensitivity and specific of serum IgA endomysial antibody testing having approached 100%
  2. Histologic findings small bowel biopsy remain the standard for diagnosis 

Treatment

  1. requires life long strict gluten free diet. All wheat rye, and barley product should be eliminated from the diet.
  2. Initially vitamin and icon supplementation is advisable.




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