A patient presents with chronic small bowel diarrhea, Duodenal biopsy shows villous atrophy Anti endomysial antibodies and IgA TTG antibodies are positive. What is the treatment of choice ?
Coeliac disease Coeliac disease is an inflammatory disorder of the small bowel occurring in genetically susceptible individuals, which results from intolerance to wheat gluten and similar proteins found in rye, barley and, to a lesser extent, oats. It can result in malabsorption and responds to a gluten-free diet. The condition occurs worldwide but is more common in nohern Europe. The prevalence in the UK is approximately 1%, although 50% of these people are asymptomatic. These include both undiagnosed 'silent' cases of the disease and cases of 'latent' coeliac disease - genetically susceptible people who may later develop clinical coeliac disease. Pathophysiology The precise mechanism of mucosal damage is unclear but immunological responses to gluten play a key role . There is a strong genetic component, with around 10% of first-degree relatives of an index case affected, and there is strong (approximately 75%) concordance in monozygotic twins. There is a strong association with human leukocyte antigen (HLA)-DQ2/DQ8. Dysbiosis of the intestinal microbiota has been identified but it is unclear if this is pathological or a response to the underlying mucosal changesIgA anti-endomysial antibodies are found in 90% coeliac patients. They are a very specific & sensitive marker for coeliac disease and dermatitis herpetiformis. The anti-endomysial antibody test has been suggested to be 98% sensitive and 98% specific for clinical or subclinical coeliac disease lying mucosal changes Ref Davidson edition23rd pg 805,806
Gluten free diet
Antibiotics
Loperamide
5-ASA
G.I.T