Case 1

A 21 year old woman had experienced diarrhoea and diffuse abdominal pain for eight months. She had four to 12 bowel movements with watery stools daily. She was initially suspected to have infectious colitis. However, as clinical investigation suggested no clear diagnosis and diarrhoea persisted, she was transferred to our department for further evaluation. At that time she had lost 11 kg and weighed 40.8 kg (body mass index 16.6). Laboratory analysis showed hypoalbuminaemia (albumin 30.7, normal range 33-50 g/l; total protein 64.3, 66-87 g/l). Further laboratory investigations (including antigastrin antibodies, antigliadin antibodies, endomysial antibodies, stool pancreatic elastase, and stool cultures) were normal. The colon had a normal macroscopic appearance on colonoscopy; histology showed no specific changes (single lymphocytes and plasma cells, no granulocytes, normal mucosal architecture) and no evidence of microscopic colitis. Findings of gastroscopy with deep duodenal biopsy, abdominal ultrasound, and computed tomography …