Summary:
At the author’s department for almost three decades bioptic and differential diagnosis of malabsorption
syndrome is made using a method elaborated and introduced by Lojda. Later the diagnosis was supplemented by
immunological examination for the presence of substances against gliadin, reticulin and endomysin in serum and
quantification of lymphocytes in the epithelium. In the submitted paper the authors tried to compare the results
of different examinations in the course of one year, to assess their significance and to recommend a suitable
diagnostic algorithm. Based on the assessed results the authors assume that the number of entrobiopsies can be
reduced as outlined below.
The first (diagnostic) biopsy is essential and is part of the standard diagnosis lege artis. Its results may or need
not confirm the dg. of coeliac disease as the cause of malabsorption syndrome. At the same time it is useful to
supplement the bioptic examination by assessment of EMA antibodies.
The second biopsy (on a gluten-free diet) may be omitted in case of previous diagnosis of coeliac disease if the patient
on the gluten-free diet has no symptoms of the disease and at the same time EMA antibodies are negative. If despite
the gluten-free diet consumed for a sufficiently long time and after elimination of other etiological causes any of the
mentioned clinical symptoms persist and/or EMA antibodies are not negative, the authors recommend biopsy.
The third biopsy (after a gluten challenge) is not essential in our view if clinical manifestations reappear and
EMA are again positive. In that case it is necessary to adhere throughout life to a gluten-free diet. If after the gluten
challenge the above described changes do not occur, authors recommend biopsy to confirm a normal finding of
the intestinal mucosa. In that case probably coeliac sprue was not involved and the diet can be more liberal. Even
then the patient should not be completely eliminated from dispensary care. Monitoring of the clinical condition
and EMA should proceed also in future after circa one-year intervals.
Key words:
coeliac sprue, malabsorption syndrome (MAS), antibodies against smooth muscle endomysin
(EMA), enterobiopsy, gluten-free diet
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