Sensitive Enteropathy

Two main forms of food-induced gastroenteropathy can be distinguished from coeliac disease eosinophilic gastroenteritis and enteropathy with villous atrophy. The very considerable literature concerning coeliac disease (gluten-sensitive enteropathy) will not be reviewed here, except to say that it is a malabsorption syndrome characterized by typical subtotal villous atrophy of the jejunal mucosa and response to a gluten-free diet. Multiple 

A food-induced malabsorption syndrome of infancy with jejunal mucosal histology similar to that of coeliac disease was first recognized with milk. However, an identical picture can be produced by soy (Ament and Rubin, 1972), and many patients with milk-induced disease become sensitive to other foods administered during the time that the mucosa is abnormal (Kuitunen et al., 1975). 

Two main features, apart from the foods involved, distinguish this syndrome from coeliac disease. First, the sensitivity and need for restriction is lifelong in coeliac disease, whereas milk-sensitive enteropathy is transient. Secondly, the jejunal mucosal changes, although similar, are usually distinguishable. Complete subtotal atrophy (flat mucosa), usual in coeliac disease, is less common in milk-sensitive enteropathy, in which various degrees of partial villous atrophy are more usual. The latter are often patchily distributed. 

Kuitunen et al. (1975) observed that the disease commenced between the first day and 22 wk of life, and that tolerance to milk had usually developed by the end of the first year. The most sensitive patients often presented in the first few weeks of life with vomiting, diarrhea, and systemic symptoms. Patients presenting later had a more chronic picture of malabsorption. The clinical response to milk provocation appears to be related to the state of the jejunal mucosa. Acute systemic reactions are common when the process is active. With more prolonged milk avoidance, overt malabsorption may recur only after several weeks of milk reintroduction (Kuitunen et al., 1975). However, even in the latter case, histological changes can be seen in the jejunal mucosa within 24 hr of provocation (Sumithran and lyngkaran, 1977). 

Food-sensitive enteropathy is frequently associated with a family history, and the clinical features, of atopy (Kuitunen et al., 1975 Harrison et al., 1976). The acute systemic reactions to milk provocation in patients with gastroenteropathy include asthma, rhinitis, and eczema (Harrison et al., 1976). Since there is some evidence for the involvement of non-reag- 

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Sardy M, Odenthal U, Karpati S, Paulsson M, Smyth N. Recombinant human tissue transglutaminase ELISA for the diagnosis of gluten-sensitive enteropathy. Clin Chem 1999 45 2142-2149. 

Chloe s medical notes show that as an infant she was admitted to the children s hospital with suspected celiac disease (gluten-sensitive enteropathy). On discharge, she was prescribed a special diet for four years. Her paediatrician then suggested the gradual introduction of foods previously excluded from her diet, such as bread and breakfast cereals. Since then she has gained weight normally and remained fairly well, except for occasional anaemia. Her blood test now shows microcytic red blood cells some of her biochemical results are shown below. 

Metal Absorption by a Subject with Gluten Sensitive Enteropathy... 

Malabsorption syndromes. Particularly in gluten-sensitive enteropathy and tropical sprue, poor absorption of folic acid from the small intestine often leads to a megaloblastic anaemia. 

Glutafin Gluten-sensitive enteropathies, N/A British National... 

You may wish to advise the patient of other items that are available on NHS prescription forms for patients with gluten sensitive enteropathies. Where would you find the necessary information Information as to which products can be prescribed on an NHS prescription can be found by consulting the Drug Tariff (see Section 2.4). Specific foods (i.e. borderline substances) can be found in the respective parts of the Drug Tariff for England and Wales (see Section 2.4.1, Part XV) or the Northern Ireland Drug Tariff (see Section 2.4.2, Part X) or in Appendix 7 of the British National Formulary (see Section 2.6.1). 

Celiac disease is sometimes called nontropical sprue, cefiac sprue, or gluten-sensitive enteropathy. 

Toxic dysgammaglobulinemia Prolonged uremia Gluten-sensitive enteropathy Diabetes mellitus without proteinuria Following severe infection Rubella in utero Cytotoxic therapy... 

Carbohydrate malabsorption can occur in a number of diseases that cause mucosal damage or dysfunction (e.g., gastroenteritis, protein deficiency, gluten-sensitive enteropathy). Disorders due to deficiencies of specific oligosaccharidases are discussed below. 

Intestinal T-cell lymphoma most often occurs in patients with gluten-sensitive enteropathy and presents with refractory, perforating ulcers in the jejunum. A mass may or may not be evident. The histology is heterogeneous, although a subset of cases comprises monomorphic medium-sized cells. Tropism for the epithelium is usually marked. Most of the intestinal lymphocytes exhibit a cytotoxic T-cell phenotype (TIA-1 and granzyme B positive) with CD56 expression relatively infrequent. 464,265 infection as assessed... 

Coeliac disease. Also known as gluten-sensitive enteropathy (GSE). A lifelong intolerance to a protein fraction of grain (e.g. gluten of wheat), leading to intestinal villous atrophy and crypt hyperplasia and characterized by specific autoimmune responses against tissue transglutaminase. 

Synonyms gluten-sensitive enteropathy, nontropical sprue Definition hypersensitivity to gluten (and gliadin), resulting in loss of small bowel villi and malabsorption... 

Rude RK and Olerigh M (1996). Magnesium deficiency possible role in osteoporosis associated with guten-sensitive enteropathy. Osteoporos Int 6 453-461. 

These authors previously found (S12) that in all of 16 women who initially had subnormal serum folate concentrations, serum folate concentrations rose within 3 months after OCAs were stopped. Subsequently they reported (SIO) 3 women with low serum folate levels while taking OCAs and low folate polyglutamate absorption that persisted after medication was discontinued. It was of interest that one of these subjects developed gluten-sensitive enteropathy a year later and a second had a family history of that disease. Other case reports of folate deficiency and mild intestinal malabsorption in users of OCAs have appeared (J3, T2, W12). It should be emphasized, therefore, that evidence of impaired folate absorption in women taking these agents may suggest the presence of inapparent small bowel disease. 

Crohn disease, gluten-sensitive enteropathy, regional enteritis, or fat malabsorption owing to surgery or infection)... 

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