Treatment of giardiasis reverses "active" coeliac disease to "latent" coeliac disease

Eur J Gastroenterol Hepatol. 2001 Sep;13(9):1101-5. doi: 10.1097/00042737-200109000-00018.

Abstract

In patients with coeliac disease, a regression of intestinal damage without a gluten-free diet is a very rare event. We describe a young child with diarrhoea, intestinal mucosa atrophy and positive serum anti-endomysial and anti-tissue transglutaminase (anti-tTG) antibodies during intestinal giardiasis infection. He showed normal intestinal mucosa architecture and negative anti-endomysial and anti-tTG antibodies after his giardiasis was cured, although he continued to assume a normal diet. Re-evaluations on a 6-monthly basis showed that he was symptom free, and all haemato-chemical parameters were within normal limits. Three years after the initial diagnosis, a third intestinal biopsy showed: normal mucosa architecture; an increase in the intra-epithelial CD3+ and gamma/delta+ lymphocyte counts; and immunoglobulin-A anti-endomysial antibody detection in the supernatant of the intestinal mucosa culture incubated with gliadin. An active coeliac disease status, with intestinal mucosa atrophy, may regress to a latent coeliac disease status with normal intestinal mucosa histology after removal of the environmental factors that have presumably precipitated mucosa damage. Serum anti-endomysial and anti-tTG antibody behaviour is not a permanent, life-long feature and this must recommend the repetition of anti-endomysial or anti-tTG antibody assays in the same patient whenever coeliac disease diagnosis is again suspected, irrespective of previous negativity.

Publication types

  • Case Reports

MeSH terms

  • Antiprotozoal Agents / administration & dosage*
  • Autoantibodies / analysis
  • Autoantibodies / blood*
  • Biopsy, Needle
  • Celiac Disease / complications
  • Celiac Disease / immunology*
  • Celiac Disease / pathology
  • Enzyme-Linked Immunosorbent Assay
  • Follow-Up Studies
  • Giardiasis / complications
  • Giardiasis / drug therapy*
  • Giardiasis / immunology*
  • Humans
  • Immunoglobulin A / analysis
  • Immunoglobulin A / blood*
  • Immunohistochemistry
  • Infant
  • Intestinal Mucosa / immunology
  • Intestinal Mucosa / pathology
  • Male
  • Sensitivity and Specificity
  • Transglutaminases / analysis
  • Transglutaminases / immunology*

Substances

  • Antiprotozoal Agents
  • Autoantibodies
  • Immunoglobulin A
  • Transglutaminases