Coeliac disease: clinical presentations, correlations of dietary compliance, symptomatic response and repeat biopsy findings.

Gastrointestinal symptoms were present at the time of diagnosis in 81 (76%) of 107 patients with coeliac disease: 56% had diarrhoea/steatorrhoea, 32.7% abdominal pain and 15% constipation. Gastrointestinal symptoms were commonest in young adults (20-39 years) and less frequent in children (0-19 years). Anaemia, low serum levels of folic acid, albumin and calcium, and raised serum alkaline phosphatase may be of help in raising the index of diagnostic suspicion, but in over half of our patients with clinically and histologically active disease these values were within normal limits. In patients adhering to a gluten free diet remission of symptoms correlated well with histological response; the continuation of symptoms indicated a higher incidence of histological abnormality. No patient not complying to the diet had normal histology on repeat biopsy. Five patients died over the ten year period, one from a small bowel lymphoma.