Gluten-free diets, coeliac disease and associated disorders

Danowski L, Garguila Brand L and Connolly J. Gluten-free diets, coeliac disease and associated disorders. Family Practice 2003; 20: 607–611. Coeliac sprue is a life-long inflammatory condition of the gastrointestinal tract that affects the small intestine of genetically susceptible individuals. This condition is a chronic malabsorptive disorder caused by exposure to dietary gluten. Villous atrophy, a lowering of the villous height to crypt depth ratio, an increase in intraepithelial lymphocytes and extensive surface cell damage and infiltration of the lamina propria with inflammatory cells are characteristic of the disease.1 Prompt improvement of nutrient absorption and healing of the intestinal mucosa is seen upon withdrawal of gluten from the diet.2 Dermatitis herpetiformis is considered an extraintestinal manifestation of coeliac sprue. This condition presents as a pruritic, blistering rash. Treament involves dapsone and a gluten-free diet, which, if strictly followed, may allow for withdrawal of the medication.1 In children, the onset of coeliac disease occurs within the first or third years of life after introduction of gluten into the diet. These children present with a classic syndrome of chronic diarrhoea, failure to thrive and abdominal distention.3 Atypical coeliac disease is seen in older children or adolescents, who display no overt features of malabsorption. In addition to recurrent abdominal pain, hypertransaminasaemia, stomatitis, arthralgia and defects in dental enamel, children may also experience depression, irritability or poor school performance.4