Coeliac disease

Coeliac disease is an autoimmune disorder of the small bowel that occurs in genetically predisposed people of all ages from middle infancy. Most common period of presentation is between six month and two years of age. Coeliac disease is caused by a reaction to gliadin, a gluten protein found in wheat. Upon exposure to gliadin, the enzyme tissue transglutaminase modifies the protein and the immune system cross reacts with the bowel tissue, causing an inflammatory reaction that leads to flattening of the lining of the small intestine, which interferes with the absorption of nutrient's. Here we describe the case of Ibrahim age 12 years was admitted in BSMMU on 9th February 2008. He had loose mucoid stool, abdominal distension, bloating and history of loss of weight for two years. He was malnourished moderately pale with clubbing. His weight and height was far below the standard for the age. Along with the routine examinations foecal fat estimation, MT, USG of whole abdomen, Barium follow through, endoscopic biopsy and tissue transglutaminage IgA autoantibody was done. Histopathological report was in favour of immunoproliferative small intestinal disease. Tissue transglutaminage IgA autoantibody was in higher level though done in a gluten free state. Wheat and food made by wheat was totally withdrawn then gradually the patient improved. Symptoms of diarrhoea, abdominal distention and bloatedness gradually decreased. For patients presenting with alteration of bowel habit, abdominal distension, bloating and history of weight loss for long time, the importance of considering coeliac diseases as a differential diagnosis cannot be overemphasized.