Gluten enteropathy appearing after gastric surgery

Four patients with severe malabsorption syndrome precipitated by gastric surgery are described. The clinical features were diarrhea, steatorrhea, and a dramatic weight loss promptly following surgery. Laboratory determinations were consistent with malabsorption syndrome. Small intestinal mucosal biopsy demonstrated villous atrophy and inflammatory cell infiltration. In each instance, a gluten-free diet led to clinical improvement and a return toward normal of the laboratory measures of absorptive function. The appearance of the proximal intestinal mucosal histology improved in 3 cases. These findings indicate that evaluation of small bowel function should be undertaken prior to gastric surgery in patients with a family or past history of celiac disease, or symptomatology suggestive of an absorptive defect. Furthermore, this study emphasizes the importance of adequate evaluation of the small intestine in patients with steatorrhea following gastric surgery. Although malabsorption in the postgastrectomy patient may result from disruption of intraluminal digestive processes, the recognition of a concomitant gluten enteropathy can lead to lifesaving dietary therapy.