Last reviewed: November 2017
Last updated: May  2016

Summary

Definition

History and exam

Key diagnostic factors

  • prolonged exposure to an endemic area
  • constitutional symptoms
  • diarrhoea
  • bloating
  • foul-smelling, greasy stools
  • swollen/sore tongue and lips
  • glossitis
  • numbness of fingers and toes

Other diagnostic factors

  • abdominal cramping
  • fever
  • leg swelling
  • hair loss
  • cheilitis/angular stomatitis
  • pedal oedema
  • hyperactive bowel sounds/borborygmi
  • hyperpigmentation/eczematous rash
  • pallor
  • dry eyes
  • corneal xerosis
  • night blindness
  • decreased deep tendon reflexes/decreased vibratory sensation

Risk factors

  • prolonged exposure to an endemic area
  • HLA antigen in the Aw-19 series

Diagnostic investigations

1st investigations to order

  • FBC
  • quantitative faecal fat assay
  • D-xylose test
  • serum folate
  • serum vitamin B12
Full details

Investigations to consider

  • stool ova and parasites (O and P)
  • stool culture
  • upper GI endoscopy with biopsy
  • folic acid therapeutic trial
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor of Medicine

Division of Gastroenterology

Duke University Medical Center

Durham

NC

Disclosures

DW declares that he has no competing interests.

Clinical Professor of Medicine

Tufts University School of Medicine

Director of Advanced Endoscopic Therapy

Division of Gastroenterology

Tufts Medical Center

Boston

MA

Disclosures

MG declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Medicine

Harvard Medical School

Division of Gastroenterology

Beth Israel Deaconess Medical Center

Boston

MA

Disclosures

JTLM declares that he has no competing interests.

Instructor in Medicine

Harvard Medical School

Director of Clinical Research

The Celiac Center

Beth Israel Deaconess Medical Center

Boston

MA

Disclosures

DL declares that he has no competing interests.

Professor of Gastroenterology

Department of Diabetes and Nutritional Sciences

Kings College London

Rayne Institute

St Thomas' Hospital

London

UK

Disclosures

PC declares that he has no competing interests.

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