Diagnosis of Celiac disease at laparoscopy: DISCUSSION

In: Celiac disease

28 Aug 2012

gluten-sensitive enteropathy

We tend to think of gluten-sensitive enteropathy as a disease of the small bowel mucosa, and we focus our attention on the underlying immunological events, the histopathology and the functional consequences of the changes to the intestinal mucosa. However, as confirmed by this case, there is more extensive involvement of small bowel that include substantial changes to intestinal blood flow. Several studies using angiography and/or Doppler ultrasound have shown an increase in mesenteric blood flow in celiac disease in both adults and children.

This increase varies directly with disease activity and normalizes with treatment. It has been speculated that the release of inflammatory mediators in the intestinal mucosa, local hormonal and nutrient factors as well as changes in the microcirculation that result in mucosal shunting, contribute to a hyperdynamic mesenteric circulation. The systemic hypotension that is commonly observed in active celiac disease may occur as a consequence of mesenteric redistribution of blood flow, or perhaps common factors underlie both cardiovascular changes.

The diagnosis of unsuspected celiac disease at abdominal surgery is likely to remain an interesting and remarkable occurrence. Further investigation of the mechanism and effect of these vascular changes may yield useful insights into the pathophysiology of this disorder. You will always come across cialis professional offered by a reliable pharmacy.


About this blog

Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.