THE PREVALENCE AND CAUSES OF CHRONIC DIARRHEA IN PATIENTS WITH CELIACSPRUE TREATED WITH A GLUTEN-FREE DIET

Background & Aims: The majority of patients with celiac sprue experien ce diarrhea before diagnosis, There have been no studies of the preval ence or causes of chronic diarrhea in these patients after treatment w ith a gluten-free diet, Methods: Seventy-eight patients with celiac sp rue (59 women and 19 men) treated with a gluten-free diet for at least 12 months were surveyed about their bowel habits, Those with chronic diarrhea, defined as passage of loose stools three or move times per w eek for 6 months, underwent an extensive diagnostic evaluation to dete rmine its cause, Results: Sixty-two of the 78 patients (79%) experienc ed diarrhea before treatment, and 13 (17%) had chronic diarrhea (of le sser severity) after treatment, The causes of diarrhea in 11 patients consenting to this study were microscopic colitis, steatorrhea seconda ry to exocrine pancreatic insufficiency, dietary lactose or fructose m alabsorption, anal sphincter dysfunction causing fecal incontinence, a nd the irritable bowel syndrome, Only 1 patient had antigliadin antibo dies detected in serum or small intestinal villous atrophy, Conclusion s: After treatment of celiac sprue with a gluten-free diet, chronic di arrhea persists in a substantial percentage of patients, Although ongo ing gluten ingestion is one possible cause, other causes may be more f requent, Therefore, diagnostic investigation of diarrhea in celiac spr ue after treatment seems warranted.