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Normal small bowel biopsy followed by coeliac disease
1University Hospital of Tampere, Department of Paediatrics, Finland.
Archives of Disease in Childhood
|October 1, 1990
Summary
Coeliac disease can be latent, presenting with normal small bowel mucosa initially. A second biopsy after gluten exposure revealed villous atrophy, confirming coeliac disease in these patients.
Area of Science:
- Gastroenterology
- Immunology
- Genetics
Background:
- Coeliac disease diagnosis typically relies on small bowel biopsy showing villous atrophy.
- Early diagnosis is crucial for managing coeliac disease and preventing complications.
Observation:
- Four patients (children to adult) initially presented with normal small bowel mucosa on biopsy.
- Biopsies were performed due to suspected malabsorption, dermatitis herpetiformis, or family studies.
- After 2.6-9 years on a gluten-containing diet, a second biopsy revealed villous atrophy consistent with coeliac disease.
Findings:
- All patients possessed HLA types typical for coeliac disease (DR3 positive).
- Family members with coeliac disease were identified.
- Some HLA-DR3 positive relatives with normal biopsies showed increased intraepithelial lymphocytes or positive antibodies.
Implications:
- Coeliac disease may remain latent, with normal small bowel mucosa in individuals consuming gluten.
- This highlights the potential for delayed diagnosis and the need for follow-up biopsies.
- Understanding latent coeliac disease is vital for accurate diagnosis and patient management.