Celiac Crisis Research Articles

Coeliac crisis in adults: report of two cases

Adult coeliac disease, in contrast to its childhood counterpart, almost always has an indolent course with a wider spectrum of clinical manifestations. Approximately half of the patients have no overt gastrointestinal symptoms and many are asymptomatic. A rare and life-threatening complication, affecting mainly children younger than 2 years of age, is the so-called coeliac crisis, a term that applies to profuse diarrhoea leading to dehydration, hypokalemia, and acidosis. We report here two cases of adult coeliac disease that presented as coeliac crisis. Coeliac disease should be a differential diagnosis in adult patients with severe acute diarrhoea and acidosis, although a rare presentation.

Celiac disease in pregnancy: not always a relapse

Sir, We are grateful to Mitchell and Robinson for their comments on our report because they allowed us to clarify that we advocate that a case finding for celiac disease (CD) should not be limited to pregnant women with ‘celiac crisis’ but should also include those with extra-gastrointestinal disorders, potentially gluten-related (1) induced by autoimmune mechanism (2). The different experience reported by Mitchell and Robinson on presentation of CD in pregnancy in comparison with what we observed may depend on a difference in clinical setting, which is likely to reflect subtle differences in referral behavior. An increased awareness of physicians not only for persistent hematological and/or gastrointestinal abnormalities but for autoimmune disorders in pregnant women can induce an increase of the CD diagnosis rate, especially in countries with a reported low prevalence of the disease. Address for correspondence: Francesco Corrado Institute of Gynecology Policlinico Universitario ‘G Martino’98100 Messina Italy e-mail: [email protected]

The use of corticosteroids in celiac crisis

The use of corticosteroids in stabilizing the clinical course of celiac crisis in three patients is described. Corticosteroids were administered to the first patient after failure to respond to a gluten-free, disaccharide-free diet; in the other two patients, corticosteroids were given as soon as celiac crisis was recognized. All showed a dramatic clinical response to corticosteroid therapy. The three patients presented with acute gastroenteritis, accompanied by shock, acidosis, hypoproteinemia, and hypokalemia. Salmonella infantis was isolated from the blood and stools of one patient. Intestinal biopsies showed severe mucosal damage. Although death from celiac disease is virtually nonexistent at present, celiac crisis may be life threatening. Corticosteroids during the acute phase may effect c rapid reversal of symptoms.

Severe Intestinal Reaction Following Ingestion of Rice

An infant with a severe gastrointestinal reaction to ingested rice was seen and studied. Many observers have concluded that rice does not contain the deleterious agent responsible for celiac disease and therefore include it in the celiac diet. 1-5 Severe reactions to rice simulating a celiac crisis have not been reported. Although rice has been implicated as a cause of minor gastrointestinal allergy, 6 it is considered a relatively nonallergenic food. It is for these reasons that the following case is of interest. Report of Case History .—This infant boy weighed 7 lb. 2 oz. (about 3,232 gm.) at birth following an uncomplicated pregnancy and delivery. He did well until age 4½ weeks at which time he began having frequent watery stools. These symptoms coincided with the onset of feeding of rice cereal. The day before and the day of admission to the hospital the child was vomiting and continuously

Management of Celiac Disease

Celiac disease (CD), perceived as a rare cause of chronic diarrhea three decades ago, was diagnosed as a cause of diarrhea in 60 (7.5%) post weaned children among 800 cases of chronic diarrhea. The diagnosis was established on the basis of a detailed clinical history, histopathological studies on small bowel mucosa and a complete recovery on gluten free diets. Thirty four children were followed up for a period of 0.3 to 8.2 years (mean 3.45 +/- 2.28). Catch up growth was seen in all. A rapid gain in height and weight was observed in first year following exclusion of gluten from the diet. However, on subsequent follow up, flattening of growth curve was seen in 9 subjects which was attributed to non-compliance of gluten free diets and dietary inadequacies. Strict dietary compliance is difficult to adhere to with wheat being a staple cereal in India. Other factors affecting compliance include lack of awareness and non availability of gluten free diets as well as contamination of other items with wheat at grocery shops. A few cases may present as celiac crisis which is a medical emergency requiring aggressive management including use of corticosteroids to improve survival in this otherwise life threatening situation. Effective management of CD requires intense family cooperation as well as concerted national efforts to provide these patients easy access to gluten free diets. The evolution of Celiac Societies, and widespread dissemination of knowledge through all available media will greatly help in management of patients with this chronic disease.