Dr. Zahoor 1

A 42 year old Saudi male was presented to us with two years of history of excessive hair fall and flatulence with recent worsening of his symptoms for further investigation and management. Additional history revealed weight loss of 10kg in the last two years and occasional episodes of diarrhea without blood or mucus. He was diagnosed as having IBS and managed accordingly. The clinical examination revealed thin, pale and ill looking patient with sunken eyes, scanty hair and angular stomatitis. On laboratory investigation, he was found to be anemic (Hb 10g/dl MCV 65), serum iron, TIBC, and Folate levels were all low. 2

Upper GI endoscopy showed loss of folds in the descending duodenum and the histopathology revealed complete villous atrophy. The serology markers were positive for antigliadin, antireticuline and anti - Endomysial antibodies. Based on the above findings, the diagnosis of celiac disease was strongly suspected and the patient was managed with gluten free diet, vitamin and minerals. He responded nicely and all his symptoms and signs improved and he had 35kg gain. Repeated duodenal biopsy after one year of the treatment showed normal villous pattern. 3

A 25 year old Saudi female was complaining of longstanding anorexia and flatulence. She was seen in different health centers and diagnosed as having IBS (Irritable bowel syndrome ) and managed accordingly with negative response. She described regular deterioration of her symptoms. On physical examination, she was pale and depressed, spleen was just palpable and lower limb edema was noticed. 4

The laboratory investigation revealed anemic patient (Hb 9.5 mg/dl and MCV 65). Her serum albumin was on the lower side. Adult celiac was entertained in the different diagnosis. Upper GI endoscopy was performed, duodenal biopsy obtained and histopathology revealed villous atrophy. The antireticuline and antiendomysial antibodies were positive, but antigliadin antibody was negative. The patient was managed as celiac disease and she responded perfectly. Repeated endoscopy and biopsy after one year showed normalization of her duodenal villi, anemia and weight (she gained 10kg). 5

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