title: The prevalence and causes of chronic diarrhea in patients with celiac sprue treated with a gluten-free diet.
abstract: OBJECTIVE
  The majority of patients with celiac sprue experience diarrhea before diagnosis. There have been no studies of the prevalence or causes of chronic diarrhea in these patients after treatment with a gluten-free diet.
  
  
  METHODS
  Seventy-eight patients with celiac sprue (59 women and 19 men) treated with a gluten-free diet for at least 12 months were surveyed about their bowel habits. Those with chronic diarrhea, defined as passage of loose stools three or more times per week for 6 months, underwent an extensive diagnostic evaluation to determine its cause.
  
  
  RESULTS
  Sixty-two of the 78 patients (79%) experienced diarrhea before treatment, and 13 (17%) had chronic diarrhea (of lesser severity) after treatment. The causes of diarrhea in 11 patients consenting to this study were microscopic colitis, steatorrhea secondary to exocrine pancreatic insufficiency, dietary lactose or fructose malabsorption, anal sphincter dysfunction causing fecal incontinence, and the irritable bowel syndrome. Only 1 patient had antigliadin antibodies detected in serum or small intestinal villous atrophy.
  
  
  CONCLUSIONS
  After treatment of celiac sprue with a gluten-free diet, chronic diarrhea persists in a substantial percentage of patients. Although ongoing gluten ingestion is one possible cause, other causes may be more frequent. Therefore, diagnostic investigation of diarrhea in celiac sprue after treatment seems warranted.
authors.affiliation: Division of Gastrointestinal Research, Baylor University Medical Center, Dallas, Texas 75246, USA.
authors.forename: K D
authors.initials: KD
authors.lastname: Fine
authors.forename: R L
authors.initials: RL
authors.lastname: Meyer
authors.forename: E L
authors.initials: EL
authors.lastname: Lee
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000503:physiopathology*; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005983:Glutens / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence
chemical_list: D005983:Glutens