Summary
Background: A 65-year-old white female who presented with flatulence and weight loss was investigated by celiac antibody testing, esophagogastroduodenoscopy, duodenal biopsy and colonoscopy. There were no positive findings, except for diverticulosis. Almost 5 years later repeat investigations performed in response to the patient's anemia confirmed the development of celiac disease. After 18 months of symptom improvement as a result of gluten exclusion the patient developed diarrhea, and colonoscopy revealed ulcerative colitis.
Investigations: Physical examination; analysis of full blood count; measurement of serum ferritin, vitamin B12, folate and C-reactive protein levels; thyroid and autoantibody profiling (including analysis of endomysial and tissue transglutaminase antibodies); CT scanning of the chest, abdomen and pelvis; and performance of esophagogastroduodenoscopy, push enteroscopy, colonoscopy and wireless capsule endoscopy.
Diagnosis: Celiac disease and ulcerative colitis.
Management: Gluten-free diet, mesalazine and prednisolone.
Nat Clin Pract Gastroenterol Hepatol. 2007;4(8):463-467. © 2007 Nature Publishing Group
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