Therapy for Celiac Disease Essay Discussion Paper
An 18 -year-old man complains of spending a small fortune on bathroom air fresheners over the past year. His main complaint however is a low volume but chronic, foul smelling diarrhea and increased gas for the past year. He has lost 10 pounds and no nausea or vomiting is present. On physical examination there is vague mild abdominal pain to palpation but no masses. Bowel sounds are active. His stool is negative for occult blood. Laboratory studies include a quantitative stool fat of 10 g/day.
1. What does this mean?
2. What is it called?
Upper GI endoscopy is performed with biopsies taken of the duodenum, and on microscopic examination show absence of villi, increased surface intraepithelial lymphocytes, and hyperplastic appearing crypts.
3. What do these findings suggest?
No bacteria or parasites are found in the biopsy tissues.
4. Why is this important?
5.What is his general diagnosis?
6. What could you do next to nail down his specific diagnosis? Be sure to think about the SPECIFIC PATHOPHYSIOLOGY occurring in this condition when considering a specific diagnosis.
7.What is his most likely diagnosis?
8.Which of the following therapies would likely be most useful to this man? Why? (10 pts.)
B Gluten-free diet
C Selective vagotomy
E Segmental duodenal resection
- A quantitative stool fat of 10 g/day means that the amount of fat in the patient’s stool is elevated, indicating malabsorption of fat in the intestine.
- The condition is called malabsorption syndrome.
- The findings on microscopic examination suggest damage to the lining of the small intestine, specifically the duodenum, which is responsible for absorbing nutrients from food. The absence of villi, increased surface intraepithelial lymphocytes, and hyperplastic appearing crypts are characteristic of celiac disease.
- The absence of bacteria or parasites in the biopsy tissues rules out infectious causes of malabsorption syndrome and supports a diagnosis of a non-infectious disorder.
- The general diagnosis is malabsorption syndrome, specifically celiac disease.
- To confirm the diagnosis of celiac disease, a blood test for anti-tissue transglutaminase antibodies and anti-endomysia antibodies can be done. These antibodies are typically elevated in patients with celiac disease. A small bowel biopsy can also be performed to examine the degree of damage to the small intestine.
- The most likely diagnosis is celiac disease, based on the patient’s symptoms, physical examination, laboratory studies, and biopsy findings.
- The most useful therapy for this man would be a gluten-free diet, as celiac disease is an autoimmune disorder triggered by gluten ingestion. Antibiotics, selective vagotomy, corticosteroids, and segmental duodenal resection would not be effective in treating celiac disease.