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Case Reports
. 2004 May 22:4:10.
doi: 10.1186/1471-230X-4-10.

Partially responsive celiac disease resulting from small intestinal bacterial overgrowth and lactose intolerance

Uday C Ghoshal  1 , Ujjala Ghoshal, Asha Misra, Gourdas Choudhuri
Affiliations
Case Reports

Partially responsive celiac disease resulting from small intestinal bacterial overgrowth and lactose intolerance

Uday C Ghoshal et al. BMC Gastroenterol. .

Abstract

Background: Celiac disease is a common cause of chronic diarrhea and malabsorption syndrome all over the world. Though it was considered uncommon in India in past, it is being described frequently recently. Some patients with celiac disease do not improve despite gluten free diet (GFD). A study described 15 cases of celiac disease unresponsive to GFD in whom small intestinal bacterial overgrowth (SIBO) or lactose intolerance was the cause for unresponsiveness.

Case presentation: During a three-year period, 12 adult patients with celiac disease were seen in the Luminal Gastroenterology Clinic in a tertiary referral center in northern India. Two of these 12 patients (16.6%), who did not fully respond to GFD initially, are presented here. Unresponsiveness resulted from SIBO in one and lactose intolerance in the other. The former patient responded to antibiotics and the latter to lactose withdrawal in addition to standard GFD.

Conclusion: In patients with celiac disease partially responsive or unresponsive to GFD, SIBO and lactose intolerance should be suspected; appropriate investigations and treatment for these may result in complete recovery.

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Figures

Figure 1
Figure 1
Course of a patient with celiac disease. Her response to gluten free diet (GFD) was inadequate despite a good compliance. This might have resulted from small intestinal bacterial overgrowth (SIBO) as addition of antibiotics with disappearance of SIBO (as evidenced by a negative glucose hydrogen breath test, GHBT) resulted in resolution of symptoms. EMA: anti-endomysial antibody.
Figure 2
Figure 2
Course of the other patient with celiac disease. Her response to gluten free diet (GFD) was inadequate despite a good compliance as she continued to pass 4–5 liquid stools/day. She was found to have lactose intolerance (LI). Inadequate response to GFD might have been due to LI as withdrawal of lactose from diet resulted in complete resolution of symptoms. Other abbreviations used: Bx: biopsy; PVA: partial villous atrophy; EMA: anti-endomysial antibody; LHBT: lactose hydrogen breath test; LT: lactose tolerance test.
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