Metabolism Studies in C liac Disease

Abstract

Since the publication of Cheadle's paper' in 1903, the presence of excess of fat in the foeces has attracted much notice as the most characteristic signi of the metabolic disturbainee in cceliac disease. It ha,s beein recognized that associated with this disturbance of fat absorption, there occuirs also a defective retention of minerals and an excessive loss of nitroge.n in the feeces. In consequence some attention hias been paid to the effect of varying the composition of the dietarv, especially fromi the therapeuitic standpoint. The interrelationship of the disturbanices in the absorption of the various elements of the diet is a m4atter of importance both from the practical point of view, an(d l)ecause of the possible value in the explanation of other metabolic disor(lers.Parsons2 has already indicated the importa,nce of vitanmin D in the preventioni of cceliac rickets, showing that the continued absence of this vitanmin from the fat-poor diets used in treatment is the cause of the rickets of convalescence. The series of observations detailed in this paper are published in the hope that some further light nay be throwin onl the und(lerlying chemical pathology of the cceliac state. A more complete understanding of the disorder should ultimately prove of value in the prevention and cure of the disease.Metabolic studies in eoliae disease are subject to the great disadva,ntage that sudden changes oecur in the condition of the patient although the diet is constant and the environment unaltered. Accordingly it is difficult to determine whether differences in the metabolic findings are to be attribuited to changes in food or other treatment, or to nattural aggravation or amelioration of the condition. In these investigations as unich care as possible was taken to rule out the idiopathic changes in the severity of the disease. A brief description of the salient featuires of the case-histories of the patients is appended at the end of the paper (see Appendix). It is proposed in the first place to summarize the metabolic findings with regard to the various forms of foodstuffs and thereafter to discuiss the bearing of these results on the chemical pathogenesis of coeliac disease.

Lymphoreticular dysfunction in idiopathic steatorrhoea.

“…In the adult patient (who may for all we know have had an abnormal mucosa since the first exposure to gluten in infancy) severe folic acid deficiency is common. This might explain the very rare description of splenic atrophy in the child suffering from coeliac disease (Meyer, 1932;Macrae and Morris, 1931) who has a short-lived mild degree of folic acid deficiency compared with the more common occurrence of atrophy in the adult with a severer degree of folic acid deficiency, possibly of long duration. In tropical sprue also, where the folic acid deficiency may be of shorter duration, the incidence of atrophy is less (Engel, 1939).…”

Metabolism in Idiopathic Steatorrhea. I. The Influence of Dietary and Other Factors on Lipid and Mineral Balance

“…One subject developed a hemorrhagic disease associated with defective coagulation of the blood. In general the metabolic abnormalities correspond to those described by Fanconi (25), Lehndorff and Mautner (32), Macrae and Morris (29), and Parsons (11) (36) in idiopathic steatorrhea of adults.…”

“…'s fecal calcium were associated with an increase in the amount of split fatty acids eliminated in the feces (see Table IV). The calcium content of the feces was considerably increased by (1) administration of a solution of sodium glycerophosphate in Period 22, (2) administration of hydrochloric acid and calcium chloride in Period 23 and (3) administration of both calcium chloride and sodium glycerophosphate in Periods 24 to 29.…”

“…The excretion of nitrogen in the feces of patients with celiac disease and idiopathic steatorrhea has often been observed to be higher than normal (8,25,29,31,32,33,34), but never attains the high levels observed in pancreatic steatorrhea. This has been considered by Thaysen (8) to be caused by factors other than defective digestion and absorption of proteins.…”

“…The conflicting opinions on the value of bile salts in steatorrhea have been discussed by Macrae and Morris (29). A purified preparation of dried ox bile 8 was given to Case J.…”