Malnutrition in adults with gastrointestinal disorders: a new reservoir of celiac disease?

To present the diagnostic process of CD Celiac disease among adults showing variable signs of nutritional derangements assisted at two tertiary-level health care institutions in Havana City (Cuba) between 2004 - 2007 for non-exhaustively characterized gastrointestinal disorders. Clinical, serological, histo-pathological and nutritional findings were integrated into an ad hoc created scoring system. Weight gain was monitored during the study observation window. Twenty-eight presumptive celiac patients were identified among those assisted. CD diagnosis was as follows: Confirmed: 17.9% (Score: 9.2 +/- 0.4); Highly likely: 60.7% (Score: 6.6 +/- 1.1); Non-conclusive: 32.1% (Score: 4.7 +/- 0.5); respectively. Ninety-two point eight percent of subjects were malnourished at the moment of the first interview. Total intestinal villi atrophy was observed in less than one-third of the identified celiac patients. Tittering of antibodies associated with CD was as follows: Anti-gliadin: Completed: 25; Positive: 72.0%; Anti-transglutaminase: Completed: 11; Positive: 54.5%. Nutritional replenishment actions comprised: Diet gluten withdrawal (100.0%); Vitamins and minerals prescription (92.9%); supplementary Enteral Nutrition (57.2%); and Parenteral Nutrition (21.4%). Weight gain was of 400 grams in 80.8% of CD patients after 33.7 days of follow- up; and of 700 grams in 13 of them after 321 days. The scoring system presented in this study could be useful for diagnosis and treatment of CD: a condition that keeps baffling physicians and nutritionists alike.