Clinical Review Lesson of the week

Atypical presentation of coeliac disease

BMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7494.773 (Published 31 March 2005) Cite this as: BMJ 2005;330:773
  1. R M Furse, locum specialist registrar1,
  2. A S Mee (anthony.mee@rbbh-tr.nhs.uk), consultant gastroenterologist1
  1. 1Department of Gastroenterology, Royal Berkshire Hospital, Reading RG1 5AN
  1. Correspondence to: A S Mee
  • Accepted 1 December 2004

Introduction

Adult coeliac disease is usually associated with a presentation of weight loss, diarrhoea, and malabsorption of nutrients. We are now seeing, however, increased numbers of silent, or subclinical, cases, which are often picked up by the finding of an unexplained anaemia.1 Despite this change, few clinicians would expect obesity to be part of the presentation. Here we describe four cases that show that we should not be dissuaded from a potential diagnosis of coeliac disease on the basis of a patient's body weight. This is especially pertinent in today's society, where 22% of men and 23% of woman in the United Kingdom are now obese (body mass index > 30).2

Case histories

Case 1

A 53 year old woman was referred to the gastroenterology department with an 18 month history of diarrhoea and a background of almost lifelong irregular bowel habit. She had always been overweight, and there had been no recent change. She weighed 131 kg (body mass index 47). Routine blood tests gave normal results apart from mild iron deficiency. She had a test for endomysial antibodies as part of her investigations, and the result was positive. Duodenal biopsies confirmed partial villous atrophy. A bone density (dual energy x ray absorptiometry) …

Sign in

Free trial

Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
Sign up for a free trial

Subscribe