Intestinal disaccharidase deficiency without villous atrophy may representearly celiac disease

Background: intestinal disaccharidase activities are decreased in untreated celiac disease and also in other conditions without villous atrophy. Of 90 8 patients examined for suspected malabsorption, 37 (4.1%) had generalized disaccharidase deficiency without villous atrophy. The aim was to determine if generalized disaccharidase deficiency without villous atrophy represent ed latent celiac disease. Methods: Case notes and histology of the 37 patie nts were reviewed. History and blood investigations including antigliadin a nd endomysial antibodies were checked. Where celiac disease was suspected, endoscopic duodenal biopsies for histology and disaccharidase estimation we re repealed. Results: Of the initial 37 patients, 6 patients had had repeat endoscopic biopsies; one having celiac disease. A further 18 patients were reviewed. The remainder declined further investigation. Eight had repeat e ndoscopic duodenal biopsies; one had celiac disease. Two with positive celi ac serology also had enteroscopy with jejunal biopsies; both had celiac dis ease. Conclusions: At least 11% of patients with generalized disaccharidase deficiency without villous atrophy develop celiac disease. Enteroscopic bi opsies from distal duodenum and proximal jejunum should be considered as th e next investigation if endomysial or antigliadin antibodies are positive.