Last reviewed: May 2020
Last updated: January  2020

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
More 1st investigations to order

Investigations to consider

  • stool ova and parasites (O and P)
  • stool culture
  • upper gastrointestinal endoscopy with biopsy
  • folic acid therapeutic trial
More investigations to consider

Treatment algorithm

Contributors

Associate Professor of Medicine

Division of Gastroenterology

Duke University Medical Center

Durham

NC

Disclosures

DW declares that he has no competing interests.

Dr Daniel Wild would like to gratefully acknowledge Dr Moises Guelrud, a previous contributor to this topic. MG declares that he has no competing interests.

Peer reviewersVIEW 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

King's College London

Rayne Institute

St Thomas' Hospital

London

UK

Disclosures

PC declares that he has no competing interests.

Use of this content is subject to our disclaimer