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

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 di arrhoea, intestinal mucosa atrophy and positive serum anti-endomysial and a ntitissue transglutaminase (anti-tTG) antibodies during intestinal giardias is infection. He showed normal intestinal mucosa architecture and negative anti-endomysial and anti-tTG antibodies after his giardiasis was cured, alt hough he continued to assume a normal diet. Re-evaluations on a 6-monthly b asis showed that he was symptom free, and all haemato-chemical parameters w ere within normal limits. Three years after the initial diagnosis, a third intestinal biopsy showed: normal mucosa architecture; an increase in the in tra-epithelial CD3+ and gamma/delta+ lymphocyte counts; and immunoglobulin- A anti-endomysial antibody detection in the supernatant of the intestinal m ucosa culture incubated with gliadin. An active coeliac disease status, wit h 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-endomy sial and anti-tTG antibody behaviour is not a permanent, life-long feature and this must recommend the repetition of anti-endomysial or anti-tTG antib ody assays in the same patient whenever coeliac disease diagnosis is again suspected, irrespective of previous negativity. (C) 2001 Lippincott William s & Wilkins.