Gluten enteropathy in patients with dermatitis herpetiformis
What is gluten enteropathy?
Gluten enteropathy, or coeliac disease, affects the majority of children and adults with dermatitis herpetiformis. It is characterised by small bowel villous atrophy. This means that instead of being highly convoluted, the lining of the intestines is smooth and flattened. The result is poor or very poor absorption of nutrients. The patient may feel well or develop the following symptoms:
- Tiredness (80%)
- Abdominal discomfort and bloating (75%)
- Weight loss (30%)
- Constipation (30%) or diarrhoea (50%)
- Pale stools that float on the surface of the toilet pan
- Bone fractures due to osteoporosis
Other features of coeliac disease
The range of conditions less commonly induced by gluten also includes:
- Neurological problems including ataxia (loss of balance), polyneuropathy, epilepsy
- Heart problems including pericarditis and cardiomyopathy
- Thin dental enamel
- Recurrent abortions (miscarriage)
- Fatty liver resulting in abnormal liver function
- Aphthous ulcers and angular cheilitis
- Dry skin
- Nail and hair abnormalities
Patients with coeliac disease sometimes suffer from other autoimmune conditions possibly associated with gluten intolerance. These include insulin-dependent diabetes mellitus, thyroiditis, autoimmune hepatitis, Sjögren's syndrome, Addison disease, atrophic gastritis, alopecia areata, vitiligo, and urticaria.
Non-Hodgkin´s lymphoma, affecting the intestines or any part of the body, is a serious complication of gluten enteropathy but is fortunately rare, affecting less than 1% of patients.
For further information about testing and treatment, see DermNet's page on dermatitis herpetiformis