There is intolerance to prolamins (proteins found in wheat, barley, rye) which results in villous atrophy and malabsorption.
Gliadin (found in gluten) is a form of prolamin.
Presentation may be with:
- abdominal pain
- weight loss
- nausea and vomiting
Patients must eat gluten for 6 weeks prior to testing.
NICE recommends diagnosis is by tissue transglutaminase (TTG) antibodies (IgA)
Endomysial antibodies and anti gliadin antibodies may also be found but are not recommended by NICE.
Jejenal biopsy may show:
- villous atrophy
- crypt hypoplasia
- raised intraepithelial lymphocytes
- lamina propria infiltrates with lymphocytes
Associations with coelic disease include:
- dermatitis herpetiformis
- type 1 diabetes
- autoimmune hepatitis
Management is by careful diet.
Now on to some botulism...