Infancy celiac disease without diarrhea

Three infants presented at about 1 year of age with failure to thrive, anorexia, vomiting, varying degrees of constipation, but no diarrhea. They were found to have severe mucosal atrophy characteristic of celiac disease. Each infant had fecal retention on admission, none had steatorrhea, and they all thrived well on gluten-free, milk-containing diets. Other investigations, including sugar tolerance tests, mucosal lactase, and dipeptidases were confirmatory. High IgA levels were found in each infant and low IgM in one. Although occurrence of celiac disease without diarrhea or steatorrhea is recognized in older children and adults, it must also be considered as a cause of failure to thrive in infants without these symptoms, particularly when other causes cannot be found.