title: Autoimmunity in diarrhoeal disease.
abstract: Evidence for autoimmunity in diarrhoeal disease is reviewed. Firstly, coeliac disease (CD) is considered. The incidence of tissue-reactive autoantibodies in both adults and children with CD (68% and 65%, respectively) is higher than the incidence of these autoantibodies in controls (6% in normal adults, and 14% and 9% in disease controls drawn respectively from adult and child populations). The R1 antireticulin antibody, when present, was found to disappear after several weeks on a gluten-free diet, but in contrast, other autoantibodies persisted. Secondly, a case is argued for a new disease category, namely "autoimmune enteropathy." Seven cases are reviewed in which patients presented with protracted diarrhoea, a small intestinal enteropathy which failed to heal during periods of total parenteral nutrition, and evidence of a predisposition to autoimmunity (namely, the presence of high titre autoantibodies including one specific for gut epithelium, and/or the presence of associated diseases regarded to be autoimmune). Thirdly, evidence for autoimmunity in inflammatory bowel disease is reviewed and includes discussion of serum goblet cell antibodies and of circulating T cells which participate in antibody-dependent cellular cytotoxicity in vitro using colonic epithelial cells as targets. Finally, an unusual child is described who presented with chronic diarrhoea and a flat small intestinal mucosa, who responded to gluten withdrawal but who later relapsed spontaneously during a strict gluten-free diet. Her mucosa healed only after a period of total parenteral nutrition and treatment with oral steroids. This child's enteropathy was also associated with thyrotoxicosis and a microscopic colitis.
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000276:immunology*; D002446:Celiac Disease / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003092:Colitis / Q000150:complications / Q000276:immunology*; D003093:Colitis, Ulcerative / Q000276:immunology; D003106:Colon / Q000276:immunology; D003424:Crohn Disease / Q000276:immunology; D003967:Diarrhea / Q000150:complications / Q000276:immunology*; D005260:Female; D005749:Gastric Inhibitory Polypeptide / Q000276:immunology; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications / Q000276:immunology; D007223:Infant; D008297:Male; D013961:Thyroid Gland / Q000276:immunology
chemical_list: D001323:Autoantibodies; D005749:Gastric Inhibitory Polypeptide