CASE 1 - ELLA
Ella is a six-year-old who wasreferred to the coeliac service by her GP. She had her IgA and tTG antibodies checked – IgA was within normal range and tTG antibodies were 55u/ml (normal range less than 7u/ml)
Ella's symptoms were faltering growth (having dropped three centiles), abdominal pain, abdominal distension, wasting of buttocks and loose stools up to eight times daily (described as Bristol stool chart type 7). She was pale, tired and had a poor appetite.
Repeat tTG antibodies along with nutritional bloods (folate, FBC, ferritin, vitamin D, parathyroid hormone, liver function tests and thyroid function tests).
- IgA -Normal range
- tTG antibody - 55u/ml; 62u/ml
- Full blood count- Haemaglobin low, MCV low, MCH low, platelets raised
- Ferritin - Low
- Folate - Low
- Vitamin D - 32
- PTH - Normal
- LFT - Albumin low, others within normal range
- TFT - Normal range
- EMA - Positive
As Ella’s tTG antibody levels were less than 10 times upper limit of normal and in view of her symptoms being highly suggestive of coeliac disease, Ella was advised to remain on a gluten-containing diet whilst awaiting diagnosis of coeliac disease. Ella was discussed with gastroenterology colleagues and proceeded to an upper GI endoscopy with small bowel biopsies.
Ella’s biopsy confirmed her diagnosis of coeliac disease with a marsh grading of 3B – showing significant villous blunting of the villi.
As a result, Ella was able to commence a gluten-free diet with support from a paediatric dietitian. In view of her low haemoglobin, ferritin, folate and vitamin D, Ella was commenced on a three-month course of folate and iron supplementation along with vitamin D therapy to optimise bone health.
Review at six months post commencing gluten-free diet
Ella attended clinic for her six-month review following commencement of a gluten-free diet. Ella reported she was well. She had no abdominal pain and her stooling had returned to normal consistency with a reduction in frequency. Ella’s parents reported she had improved appetite and energy levels and Ella had gained 5kg since diagnosis.