SGD: Carbohydrate Metabolism
Topic: Gluten sensitivity
Trigger 1
Gluten-sensitive enteropathy (GSE), common in
Western Europe and Scandinavian countries, is a chronic disease causing
malabsorption and resulting in mucosal damage in the small bowel
associated with genetic susceptibility. The main cause of the disease is
hypersensitivity to a component of gluten, gliadin, which is alcohol
soluble.
Gluten consists of the prolamines of wheat, rye, barley and
oats. Although the etiopathogenesis of the mucosal damage is not well
known, it is thought to be the result of abnormal cellular immune
response to gluten, which is determined genetically.
Trigger 2
As a consequence of
continuing concern of pediatricians for a condition estimated to be
more frequent in children than in adults, and which cannot be
characterized unequivocally by its intestinal lesions, the European
Society for Pediatric Gastroenterology and Nutrition (ESPGAN) finally
issued its most rigorous criteria of the disease in 1990. These criteria consist of:
i. a state of malabsorption with total or subtotal villous
atrophy of the intestinal mucosa observed while the diet contains gluten
ii.
cure of the clinical disorder and histological lesions following gluten
withdrawal.
Trigger 3
Although GSE presents with chronic diarrhea, failure to
thrive (FTT) and clinical fatigue, it is known that the disease may develop
years later without malabsorption and with a normal mucosa. Today, it is
believed that GSE has a histopathological spectrum, and that
it is thus necessary to make a detailed typing demonstrating this
spectrum.
Suggested reading
http://www.turkgastro.org/text.php?id=105
Discussion points
- What is gluten-sensitive enteropathy (GSE) or coeliac disease (CD)?
- What are the features of GSE/CD?
- What are the changes seen (if any) in the ileum in GSE/CD?
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