Gluten Induced Enteropathy

Question 1

What is the pathophysiology behind GIE

Answer 1

Disorder characterised by malabsorption, abnormal small bowel structure and intolerance to gluten

Question 2

What are the clinical features of GIE?

Answer 2

Diffuse damage to proximal small intestinal mucosa that results in malabsorption of mostly nutrients

Question 3

What is the age of onset?

Answer 3

Can happen at infancy but also between 20-40 years of age

Question 4

What are the symptoms and signs of GIE

Answer 4

Diarrhoea
Flatulence
Weight loss
Weakness
Stools are soft, large, greasy or watery
Constipation in those with minimal involvement of duodenum and proximal jejunum

Question 5

What will the physical examination show?

Answer 5

Can be normal or signs of malabsorption eg loss of muscle mass or subcutaneous fat, pallor due to anaemia
Bone pain due to vitamin k deficiency
Abdominal exam shows distension with hyper active bowel sounds
Dermatitis herpetiformis (skin rash) in 10%

Question 6

What will show non the lab findings for GIE?

Answer 6

Decreased complete iron
Decreased vitamin B12
Decreased red cell folate
Decreased serum calcium
Increased alkaline phosphatase
Decreased albumin
Decreased beta carotene
Increased PPT (partial thromboplastin time)
Hypokalemia

Question 7

What is the treatment for GIE?

Answer 7

Remove all gluten from diet
Rice, soybean, potato and corn flours are fine
Improvement in symptoms should be evident in a few weeks of a gluten free diet