Autoimmunity in Diarrhoeal Disease

Abstract

Evidence for autoimmunity in diarrhoeal disease is reviewed. Firstly, coeliac disease (CD) is considered. The incidence of tissue‐reactive autoantibodies in both adults and children with CD (68% and 65%, respectively) is higher than the incidence of these autoantibodies in controls (6% in normal adults, and 14% and 9% in disease controls drawn respectively from adult and child populations). The Rr an‐tireticulin antibody, when present, was found to disappear after several weeks on a gluten‐free diet, but in contrast, other autoantibodies persisted. Secondly, a case is argued for a new disease category, namely “autoimmune enteropathy.” Seven cases are reviewed in which patients presented with protracted diarrhoea, a small intestinal enteropathy which failed to heal during periods of total parenteral nutrition, and evidence of a predisposition to autoimmunity (namely, the presence of high titre autoantibodies including one specific for gut epithelium, and/or the presence of associated diseases regarded to be autoimmune). Thirdly, evidence for autoimmunity in inflammatory bowel disease is reviewed and includes discussion of serum goblet cell antibodies and of circulating T cells which participate in antibody‐dependent cellular cytotoxicity in vitro using colonic epithelial cells as targets. Finally, an unusual child is described who presented with chronic diarrhoea and a flat small intestinal mucosa, who responded to gluten withdrawal but who later relapsed spontaneously during a strict gluten‐free diet. Her mucosa healed only after a period of total parenteral nutrition and treatment with oral steroids. This child'S enteropathy was also associated with thyrotoxicosis and a microscopic colitis.