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Re: Flattening of Villa in Small Bowel

Posted By HFHSM.D.-sg on June 29, 1998 at 21:05:23:

In Reply to: Flattening of Villa in Small Bowel posted by Mithranda on June 24, 1998 at 15:03:53:

4 yrs ago, after a small bowel biopsy, I was diagnosed with Celiac Sprue.  I was told the biopsy showed flattening and destruction of the villa.
I tried a gluten-free diet for 2 yrs.  Some symptoms improved, others did not.  My weight, which had been 110-120, dropped to 85 lbs.  
Is there anything else that could cause the damage the biopsy showed?  I was told the diagnosis was confirmed by improvement on the diet, which was not very conclusive.  What other diseases could be responsible?

Dear Mithranda:
Celiac Sprue is caused by an immune response to gluten, a protein found in several grains including wheat, barley and rye.  Antibodies are produced and inflammatory cells migrate into the lining of the small intestines leading to flattening and damage of the villi . The histologic picture of flat villi is not specific to celiac disease and can be seen in other food allergies.
Patients with Celiac Sprue are advised to strictly adhere to gluten-free diet forever.  Only in this way can they prevent activation of the disease.  You write that you have been diagnosed to have Celiac Sprue for 4 years but have only been on a gluten-free diet for 2 years.  The continued weight loss may represent your failure to be completely free of gluten.  It is essential to read labels of all prepared foods and to be very careful when you eat out.  If you have not done so, you should meet with a dietitian to review gluten-free diets.
If you have been on a gluten-free diet and are still symptomatic it is necessary to consider other possible explanations,  First you should have a blood test (anti endomysial antibody) to confirm the diagnosis of sprue. Several other diseases can give the flat villi including eosinophilic enteritis, tropical sprue, milk or soybean protein intolerance, and parasitic infestations. If you have sprue, it is necessary to exclude collagenous sprue, a variant that does not improve with a gluten-free diet.  Also your doctor should exclude intestinal lymphoma, a complication of sprue.  Finally, it is necessary to exclude other causes for your weight loss e.g. hyperthyroidism.
This information is presented for educational purposes only.  Always consult your personal physician for specific medical questions.
If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital and perform the appropriate investigations after we have had the chance to meet you and to review your history in greater detail. You can arrange an appointment with Dr. Fogel, one of our experts in the diagnosis and treatment of gastrointestinal disease by calling the Henry Ford Physician Referral Line at (800)653-6568.
*keywords: celiac disease

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