Intestinal Ulceration – A Complication of Celiac Disease

Bayless, Theodore M.; Kapelowitz, Robert F.; Shelley, William M.; Ballinger, Walter F.; Hendrix, Thomas R.

doi:10.1056/nejm196705042761802

Cited by 112 publications

(38 citation statements)

References 23 publications

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“…Nonspecific ulceration of the small bowel has been described in coeliac disease (Bayless, Kapelowitz, Shelley, Ballinger, and Hendrix, 1967). The cause is unknown.…”

Section: Discussionmentioning

confidence: 99%

“…The cause is unknown. It has been suggested that the high rate of cell loss which occurs in coeliac disease may result in a failure of epithelial cell regeneration leading to ulceration (Davidson, 1969 (Bayless et al, 1967;Davidson, 1969) the ulceration can be seen in areas where the villous architecture is undisturbed. It has been shown that normal mucosal architecture infers a normal rate of cell loss (Loehry and Creamer, 1969).…”

Section: Discussionmentioning

confidence: 99%

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A case of small-intestinal mucosal atrophy

Morris¹,

Read²

1970

Gut

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“…Nonspecific ulceration of the small bowel has been described in coeliac disease (Bayless, Kapelowitz, Shelley, Ballinger, and Hendrix, 1967). The cause is unknown.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A case of small-intestinal mucosal atrophy

Morris¹,

Read²

1970

Gut

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“…Monoclonal aberrant T-cell abnormality is the postulated pathogenesis [53,85]. Patients continue to experience symptoms of diarrhea, abdominal pain and malabsorption despite being on a GFD [86,87]. Workup includes an exclusion of malignancy [69,76,88,89] (EATL and small bowel adenocarcinoma) with an abdominal CT enterography or MR Enterography.…”

Section: Ulcerative Jejunitismentioning

confidence: 99%

Gluten and the Gut: A Brief Review of Gluten-Related Gastrointestinal Disorders

Shah¹

2017

SOJI

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We conducted online electronic searches (published manuscripts in English) of the Cochrane Library, pub med and manual searches of selected specialty journals to identify any pertinent literature. The search was conducted using the key words 'celiac disease', 'gluten related disorder', 'non celiac gluten sensitivity', 'wheat allergy', 'gluten', , 'gluten free diet'. Studies not published in English or published only in the abstract form were excluded. We also conducted a focused review of available references to identify subsequent pertinent papers. AbstractCeliac disease (CD) was the first gluten-related disorder to be described. Presently the realm of gluten-related disorders also includes non-celiac gluten sensitivity (NCGS) and wheat allergy (WA). CD is a multisystem immune mediated enteropathy observed in genetically susceptible individuals exposed to dietary gluten present in barley, rye and wheat. Although the prevalence of CD is on the rise, it still largely remains under diagnosed given that many cases can be silent, subtle or atypical. The Pathophysiology of CD includes both innate and adaptive immune response to dietary gluten. Patients present with a wide variety of intestinal and extra-intestinal symptoms and are at risk for non-Hodgkin's lymphoma and small intestinal adenocarcinoma. The corner stone for treatment of CD is a gluten-free diet (GFD). NCGS is an emerging condition associated with gluten ingestion and the diagnosis of which is based on exclusion of CD and WA. Further evidence and studies are required to fully appreciate the clinical entity of NCGS and WA to detail its epidemiology and pathogenesis. The symptoms of NCGS and WA may overlap with CD and hence it is imperative to differentiate these clinical entities and select patients for appropriate management.Keywords: Celiac disease, gluten related disorder, non-celiac gluten sensitivity, wheat allergy, gluten, epidemiology, clinical features, Pathophysiology, management, gluten free diet.Core tip: CD is largely under-diagnosed while the incidence and prevalence of gluten-related disorders are on the rise. A clear understanding of the various clinical presentations of gluten-related disorders can help differentiate CD from NCGS and WA. The management for these conditions differs and hence accurate diagnosis leads to improved patient outcomes with avoidance of longterm complications as well as unnecessary testing which can be both invasive and expensive. Celiac DiseaseThe term celiac is derived from the Greek word "koiliaks" meaning "abdominal". It was first described in the second century in modern day Turkey by a Greek physician Aretaeus of Cappadocia [1]. In 1888, Samuel Gee; a pediatrician from the United Kingdom gave the first modern-day description of the condition and associated diet to the treatment of celiac disease EpidemiologyCeliac disease occurs in about 1% of the general population worldwide [7]. Data from the USA suggests CD to be more common in Caucasians as compared to African-Americans and Hispanics [8,9]. The initial ...

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“…The suggestion, in 1967, that the ulceration is a complication of CD [66] was on the basis of a collection of case records. The strength of the evidence of ulceration being due to CD is very variable from case to case [67] but does include some incontrovertible cases.…”

Section: Ulceration Of the Small Intestinementioning

confidence: 99%

A History of Coeliac Disease

Losowsky¹

2008

Dig Dis

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Coeliac disease may have an ancient history dating back to the 1st and 2nd centuries AD. The first clear description was given by Samuel Gee in 1888. He suggested that dietary treatment might be of benefit. In the early 20th century various diets were tried, with some success, but without clear recognition of the toxic components. The doctoral thesis of Wim Dicke of 1950 established that exclusion of wheat, rye and oats from the diet led to dramatic improvement. The toxicity was shown to be a protein component, referred to as gluten. Dicke’s colleagues, Weijers and Van de Kamer, showed that measurement of stool fat reflected the clinical condition. Early studies were in children but stool fat measurements documented that the condition could be recognised in adults. Histological abnormalities of the lining of the small intestine were demonstrated beyond doubt by Paulley in 1954 and techniques of per-oral biopsy described by Royer in 1955 and Shiner in 1956 afforded reliable diagnosis. Concurrence in monozygotic twins suggested a genetic component, confirmed by studies of HLA antigens. Additional, non-genetic factors seem likely. Circulating antibodies suggest an immunological mechanism of damage and provide non-invasive screening tests. Lymphoma, adenocarcinoma and ulceration of the small intestine and a range of immunological disorders are associated. A relationship with dermatitis herpetiformis was suggested by Samman in 1955 and established by Shuster and Marks in 1965 and 1968. The Coeliac Society (now Coeliac UK) was founded in 1968 and similar societies now exist across the world. They provide an extremely valuable service. Present problems include definition of the tolerated levels of gluten, whether oats are toxic for some or all coeliacs and the likelihood that the condition is relatively common and frequently without classical symptoms. Hope for the future is that more convenient methods of treatment will follow better understanding.

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Intestinal Ulceration – A Complication of Celiac Disease

Cited by 112 publications

References 23 publications

A case of small-intestinal mucosal atrophy

A case of small-intestinal mucosal atrophy

Gluten and the Gut: A Brief Review of Gluten-Related Gastrointestinal Disorders

A History of Coeliac Disease

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