Non-neoplastic intestinal disease Malabsorption Paul L. Crotty Department of Pathology Tallaght Hospital October 2007. Outline of lecture. Review normal digestion/absorption How diseases interfere with the process Tests for malabsorption Coeliac disease Chronic pancreatitis
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Non-neoplastic intestinal disease
Paul L. Crotty
Department of Pathology
Normal process of fat digestion and absorption
17 centuries later...
1950: Paulley identified villous abnormality
Later shown that the histological abnormality normalised after gluten withdrawal and recurred after gluten challenge
Alpha-GLIADIN PEPTIDES (SYNTHETIC) FOR WHICHTHERE IS IN VIVO EVIDENCE OF ACTIVITY
Ingestion of gluten (or alpha-gliadin or even synthetic peptides) by a patient with coeliac disease causes symptoms in few hours and villous abnormality in 8-12 hours
Why are gliadins toxic in some patients and not in others?
IgA 89% 95%
IgG 99% 86%
EMA >95% >95%
tTG (IgA/IgG) >95% >95%
IgA tests negative in the 2-3% of coeliacs with IgA deficiency