Diagnosis of Celiac disease at laparoscopy: CASE PRESENTATION

In: Celiac disease

27 Aug 2012

Small bowel radiography was normal and at endoscopy ‘scalloping’ was seen in the proximal small bowel. The immunoglobulin G antiendomysial antibody titre was positive to 1:1280 (normal less than 1:2.5) and the lactulose/mannitol ratio was increased to 0.092 (normal less than 0.025). Severe villous atrophy, crypt hyperplasia and inflammatory infiltrate consistent with celiac disease was seen in the histopathology of the duodenum (Figure 2). Bone densitometry revealed osteopenia.

At follow-up one month following initiation of a gluten-free diet, she felt well. Management of her diabetes had become somewhat more problematic because of a rise in her blood glucose levels and her abdominal discomfort had improved. She did not return for follow-up evaluation after six to nine months, as recommended, and was subsequently interviewed by telephone. This revealed that, initially, on gluten restriction she had considerable difficulty controlling her diabetes and experienced a gain in weight from 44.5 kg to 50 kg. She continues to be free of gastrointestinal symptoms 18 months following initiation of a gluten-free diet.

Photomicrograph of small bowel

Figure 2) Photomicrograph of small bowel demonstrating villous atro-phy, crypt hyperplasia and an inflammatory infiltrate with prominent intraepithelial lymphocytosis (inset)

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