[The Pediatric Association recommends: Oats can be implemented in the gluten-free diet].
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Stomatological examination was carried out of 38 children with coeliac disease. The condition of teeth with regard to caries was better than in children without coeliac disease. Occlusal abnormalities were noted in one-third of patients, in one-third of children with mixed teeth the dental age was delayed in relation to calendar age. No periodontal and mucosal changes were observed. The state of oral hygiene was estimated as good.
The paper reports the results of a preliminary study using indirect immunofluorescent methods on serum samples from 20 patients affected by dermatitis herpetiformis in various phases of development and from 7 patients affected by celiac disease in order to document the presence of anti-endomysium IgA antibodies. Serum samples from 10 patients affected by bullous pemphigoid, 1 patients with linear IgA dermatitis and 10 patients with other bullous dermatosis were included as controls. Whereas the presence of these antibodies in varying titres, ranging from 1:10 to 1:80, was confirmed in all case of dermatitis herpetiformis, no antibody activity was observed in control patients. On the basis of these findings and of other published data, it is possible to conclude that these antibodies are directly correlated to intestinal damage, but there is no relationship with the clinical characteristics of skin symptoms or with junctional immunopathological evidence.
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Eight children with primary and secondary enteropathy were examined, in whom predominantly advanced partial atrophy and subtotal atrophy of the villous apparatus were established. Enzymic histochemical study of the activity of alkaline phosphatase showed correlation with the degree of villous atrophy. Our results confirm that the alkaline phosphatase is an enzyme, indicating regenerative activity of enterocytes.
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In a 60-year-old patient with adult celiac disease complete clinical remission was achieved with a glutenfree diet, but symptoms of sprue subsequently recurred despite rigid adherence to dietary restrictions. Further investigations revealed simultaneous occurrence of two severe complications of celiac disease: collagenous sprue and ulcerative jejunoileitis. The patient died after a 2 1/2 year course of refractory, severe, relentlessly progressive malabsorption. In the light of the literature and this observation it is postulated that in every case of primary or secondary refractory celiac disease complications must be sought: to diagnose collagenous sprue, aspiration biopsy from the proximal jejunum, and possibly also from the terminal ileum, may be more efficient than simple endoscopic biopsy from the descending duodenum. If the diagnosis of collagenous sprue can be established, therapy with steroids should be attempted. The diagnosis of ulcerative jejunoileitis is usually missed by radiology and requires exploratory laparotomy.
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