When is celiac disease not celiac disease?

Česká verzia

Authors: Petra Koňaříková; V. Kojecký
Authors place of work: Gastroenterologie, Interní klinika Krajská nemocnice T. Bati, a. s., Zlín
Published in the journal: Gastroent Hepatol 2017; 71(1): 58-61
Category: Klinická a experimentální gastroenterologie: kazuistika
doi: https://doi.org/10.14735/amgh2016csgh.info18

Summary

Despite the high the prevalence of celiac disease in the European population (around 1%), this disease is often not diagnosed and in some cases the diagnosis takes place when the disease is in the advance stages. Diagnosing celiac disease is not always unequivocal and because it requires a lifelong gluten-free diet, it should be done in a sensible way. Diagnosing celiac disease is based on the conclusiveness of different serological markers and on the presence of a typical coeliac histology that responds to a gluten-free diet. In cases of typical disease progress, the diagnosis is usually clear. Doubts may arise when other diseases mimic the symptoms of celiac disease or when a non-standard or missing serological response occurs. Our case study describes a 30-year-old patient whose diagnosis of celiac disease could not be confirmed or refuted, even after several years of considerable effort. At the beginning of monitoring, the patient was diagnosed with celiac disease based on the presence of characteristic histological findings in a membrane biopsy of the duodenum (Marsh 3). Despite the patient maintaining a variable diet, the histological changes regressed but without loss of isolated positivity to endomysial antibodies. We therefore considered diseases other than celiac disease that might be responsible for the patient’s symptoms. Subsequently, lamblioza was confirmed in a secretion from the duodenum. Even after treatment, the patient was kept on gastroenterological dispenzarization and on a normal diet with working diagnosis of potential sprue.

Key words:
celiac disease – differential diagnosis – duodenitis – Giardia lamblia

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
25. 2. 2016

Accepted:
2. 4. 2016

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