Strike 2 against the gluten theory

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Scand J Gastroenterol. 2001 Feb;36(2):163-8.

Intestinal disaccharidase deficiency without villous atrophy may represent

early celiac disease.

Murray IA, JA, Coupland K, Ansell ID, Long RG.

Dept. of Gastroenterology, City Hospital, Nottingham, UK.

iainmurray10@...

BACKGROUND: Intestinal disaccharidase activities are decreased in untreated

celiac disease and also in other conditions without villous atrophy. Of 908

patients examined for suspected malabsorption, 37 (4.1%) had generalized

disaccharidase deficiency without villous atrophy. The aim was to determine

if generalized disaccharidase deficiency without villous atrophy

represented latent celiac disease. METHODS: Case notes and histology of the

37 patients were reviewed. History and blood investigations including

antigliadin and endomysial antibodies were checked. Where celiac disease

was suspected, endoscopic duodenal biopsies for histology and

disaccharidase estimation were repeated. RESULTS: Of the initial 37

patients, 6 patients had had repeat endoscopic biopsies; one having celiac

disease. A further 18 patients were reviewed. The remainder declined

further investigation. Eight had repeat endoscopic duodenal biopsies; one

had celiac disease. Two with positive celiac serology also had enteroscopy

with jejunal biopsies; both had celiac disease. CONCLUSIONS: At least 11%

of patients with generalized disaccharidase deficiency without villous

atrophy develop celiac disease. Enteroscopic biopsies from distal duodenum

and proximal jejunum should be considered as the next investigation if

endomysial or antigliadin antibodies are positive.

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