Pathology: Immune-mediated destruction of villi in the proximal small bowel due to exposure to gluten, usually diagnosed in childhood, can present in adulthood with anaemia or new onset diarrhoea in adulthood
Aetiology: Commonest in white Europeans. Associated with other autoimmune disorders such
as Type 1 Diabetes, IgA deficiency, Sjögren Syndrome, Rheumatoid Arthritis
Symptoms: Lethargy, steatorrhoea, diarrhoea, frothy foul smelling stool, weight loss, vitamin deficiency, iron deficiency, osteoporosis
Signs: Pallor, dermatitis herpetiformis (itchy rash on extensor surfaces), distended abdomen, mouth ulcers
Investigations: Bloods: FBC, U&E
Auto-Antibody Screen: Tissue Transglutamase and Anti-endomysial positive
OGD: Duodenal biopsies show villous atrophy and crypt hyperplasia
Treatment: Conservative: Gluten free diet
Medical: Steroids and immunosuppression for refractory disease
Complications: Susceptibility to GI malignancy, T-Cell lymphoma, Anaemia, Osteoporosis
Prognosis: 70% improve within 2 weeks of a gluten free diet.
Figure 3.3 Dermatitis Herpetiformis
Pathology: Chronic relapsing functional bowel disorder, constipation predominant, diarrhoea predominant or alternate between the two.
Aetiology: Unknown, IBS is common, highest prevalence in young women
Altered motility and visceral hypersensitivity are implicated in causing the symptoms of IBS
Symptoms: Diarrhoea, constipation, abdominal pain, bloating, relieved by defecation, passing mucous, increased flatulence
Signs: Abdominal bloating, Sensation of incomplete defecation
Investigations: Bloods: FBC, U&E, TFTs, Faecal Calprotectin – marker of bowel inflammation
Auto-Antibody Screen: Tissue Transglutamase and Anti-endomysial negative
Microbiology: Stool culture
Treatment: Conservative: Lifestyle advice
Medical: Antispasmodics for pain, anti-diarrhoeal agents, laxatives
Complications: Can lead to anxiety and depression
Prognosis: 50% improve after 1 year.
Pathology: Defined as hard stools with straining on defecation, sensation of incomplete evacuation and fewer than three defecations per week
Aetiology: Increased age, inadequate fibre, drugs (opiates, anticholinergics, iron), slow bowel transit, constipation, spinal cord lesions, Hirschsprung’s disease, Chagas’ disease, autonomic neuropathy, hypothyroidism, hypercalcaemia, hypopituitarism, Addison’s disease
Symptoms: Straining, sensation of incomplete evacuation, requiring manoeuvres to open bowels, manual evacuation
Signs: Tenesmus
Investigations: Bloods: FBC, U&E, LFT, TFTs and Calcium
Imaging: Colonic transit study
Treatment: Conservative: Lifestyle advice and increased dietary fibre
Medical: Laxatives
Complications: Anal fissure, chronic haemorrhoids, faecal impaction
Prognosis: Good prognosis with treatment
