Small intestinal function and dietary status in dermatitis herpetiformis

Article Abstract:

Dermatitis herpetiformis is a chronic inflammatory disease of the skin, characterized by burning, itching lesions. The cause of this condition is unknown, but it often occurs simultaneously with pathological changes of varying severity in the small intestine. The intestinal condition resembles an inflammatory bowel disease, characterized by hypersensitivity to dietary gluten, known as celiac disease. Controversy exists over whether all patients with dermatitis herpetiformis have variable degrees of intestinal pathology, or form two distinct groups: those with normal small intestinal morphology, and those with symptoms of celiac disease. To further investigate this question, 82 patients (55 men and 27 women) with dermatitis herpetiformis, 31 of whom were taking a gluten-free diet (the remainder were eating a normal diet), were studied. Intestinal function was determined in a variety of ways: multiple intestinal biopsies were taken, intestinal permeability was determined, enzymes involved in carbohydrate metabolism were assayed, blood levels of antigliadin antibodies (of which celiac disease patients have high levels) were determined, and dietary gluten intake was measured. Thirty-three of the patients had histological signs that were abnormal. Among patients who were eating various amounts of gluten in their diet, there was no correlation between gluten intake and degree of anatomical abnormality of the intestine; all patients on the gluten-free diet had normal intestinal morphology. Tests revealed that virtually all patients had normal intestinal function. However, most patients with any degree of intestinal disease were shown to have antigliadin antibodies. Hence, most patients with dermatitis herpetiformis manifest some sort of anatomical or functional aberration, but there is a low percentage (in the present study 7 of 51, or 14 percent) with entirely normal intestines, in spite of unlimited dietary gluten intake. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Physiological aspects, Intestine, Small, Small intestine, Gluten-free diet, Dermatitis herpetiformis

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Partial lipodystrophy in coeliac disease

Article Abstract:

Lipodystrophy is a disturbance in fat metabolism. Partial lipodystrophy (PL) is characterized by a reduction in fat tissue in all areas above the waist, while the lower body retains normal amounts of fat. In addition, there is a deficit in one of the complement proteins (a group of blood proteins which destroy bacteria). The cause is unknown, but PL is associated with a number of other disorders. However, an association with celiac disease (CD), an intestinal disorder treated by eliminating gluten from the diet, and dermatitis herpetiformis (DH), a gluten-related disorder, has not been previously reported. A case is reported of an 18-year-old woman who was diagnosed with CD at age seven. CD symptoms resolved after starting a gluten-free diet, but the patient developed bronchial asthma and PL within a year, and skin changes indicative of DH subsequently appeared. In addition to low levels of C3 complement, the patient had low levels of a type of antibody, immunoglobulin A. The patient is currently being monitored for development of kidney disease, which is common in cases of PL. The study emphasizes the distinctiveness of upper body wasting which may be erroneously attributed to the intestinal malabsorption which accompanies celiac disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Lipodystrophy

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