Cookie policy: This site uses cookies (small files stored on your computer) to simplify and improve your experience of this website. Cookies are small text files stored on the device you are using to access this website. For more information please take a look at our terms and conditions. Some parts of the site may not work properly if you choose not to accept cookies.

Join

Subscribe or Register

Existing user? Login

Coeliac disease - A case study

By Pamela Mason

Alison is a 32-year-old woman who has a history of bowel frequency with occasional bouts of constipation going back over 15 years. About 12 months ago, she was diagnosed by her doctor as having irritable bowel syndrome (IBS) for which she has occasionally tried mebeverine tablets with little beneficial effect. Today she comes to the pharmacy and asks for a medicine for diarrhoea. On questioning, Alison says she had a meal in an Italian restaurant yesterday evening after which she began to suffer what she felt to be the worst bout of diarrhoea and abdominal pains she had experienced for several years. She then admits that her bowels do seem to have been more troublesome than normal recently, and she is beginning to feel very miserable.

How would you advise Alison?

The history here is not straightforward. Although the symptoms Alison describes could be indicative of IBS, other possibilities should be considered. Alison should therefore be referred to her general practitioner.

About a week later Alison returns to your pharmacy with a prescription for erythromycin for her four-year-old son. At the same time she tells you that her GP has referred her to a gastroenterologist for tests for coeliac disease.

What is coeliac disease?

Coeliac disease is a condition where there is a permanent intolerance to gluten. This results in stunting and disorganisation of the intestinal villi, with lymphocytic infiltration of the epithelial surface and malabsorption of nutrients.

What is gluten?

Gluten has been defined as the viscoelastic mass which remains when a wheat flour dough is washed exhaustively in tap water. The term has now been extended to include all those proteins which are harmful to individuals with gluten sensitivity, ie, the storage proteins of wheat, rye, barley and, possibly, oats (the role of oats in this regard is now much in doubt). Within wheat gluten, it is the gliadin (a simple protein seperable from wheat gluten) fraction that is known to trigger disease in susceptible individuals.

How does gluten exert its harmful effects?

Several hypotheses have been developed as to the aetiology of coeliac disease. Initially, it was thought that incomplete brush border hydrolysis of gluten occurred as a result of a deficiency of mucosal peptidase or carbohydrase, leading to the formation of toxic products. However, inability to show low activity of such enzymes following treatment with a gluten-free diet rendered this idea untenable. There is now growing acceptance that the immune system is involved. Ingestion of gluten activates T-cells in the small intestine, which results in release of inflammatory mediators. This causes damage to the absorptive surface of the small bowel and malabsorption of nutrients.

Download the attached PDF to read the full article.

Citation: The Pharmaceutical Journal URI: 10978488

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

Recommended from Pharmaceutical Press

  • Developing Your Prescribing Skills

    Developing Your Prescribing Skills

    Developing Your Prescribing Skills uses case studies, mind maps and feedback from experienced prescribers. It supplies practical advice on the issues facing prescribers in all types of practice.

    £23.00Buy now
  • Workplace Drug Testing

    Workplace Drug Testing

    Explains drug testing regulatory frameworks and all aspects of drug analysis. Case studies of successful programmes are included.

    £81.00Buy now
  • Social and Cognitive Pharmacy

    Social and Cognitive Pharmacy

    Social and Cognitive Pharmacy is a practical handbook for learning and teaching sociology and psychology, and applying this to pharmacy practice.

    £33.00Buy now
  • Clinical Pharmacokinetics

    Clinical Pharmacokinetics

    A practical guide to the use of pharmacokinetic principles in clinical practice. Includes case studies with questions and answers.

    £33.00Buy now
  • Prescribing Adult Intravenous Nutrition

    Prescribing Adult Intravenous Nutrition

    A practical guide to the principles and practice of adult intravenous nutrition. With numerous illustrations and case studies.

    £40.00Buy now

Search an extensive range of the world’s most trusted resources

Powered by MedicinesComplete
  • Print
  • Share
  • Comment
  • Save
  • Print Friendly Version of this pagePrint Get a PDF version of this webpagePDF

Supplementary information

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.