Internal Medicine (Theory) · MU Sofia

35. Acute and chronic enteritis: gluten enteropathy (celiac disease)

Covers acute infectious and other causes of small-intestine inflammation, then chronic enteritis with coeliac disease as the main focus, including its gluten-driven immune mechanism, genetic links, and malabsorption. It goes on to symptoms, physical signs, laboratory and biopsy-based diagnosis, treatment with a lifelong gluten-free diet, and complications. A summary table of gold-standard tests for acute enteritis and coeliac disease closes the note.

Inside: 10 sections · 4 labelled pictures · 1 table · 15 flashcards · 3 min

Topic 33 of 58 in the MU Sofia syllabus for Internal Medicine (Theory) (Medicine, Year 3). The free AceMed note covers it in 10 sections, about 331 words (3 min of reading), with 15 flashcards.

In this note

  1. Acute and Chronic Enteritis; Gluten Enteropathy (Celiac Disease)
  2. Definition:
  3. ⚠️ Etiology / Risk Factors:
  4. Pathogenesis (Celiac Disease):
  5. Symptoms:
  6. Physical Examination:
  7. Lab and Diagnostic Tests:
  8. Treatment:
  9. Complications:
  10. Summary of Gold Standards:

Definition:

  • Acute enteritis: Inflammation of the mucosa of the small intestine, usually infectious.
  • Chronic enteritis: Persistent inflammation, may be autoimmune (e.g., Crohn’s, celiac).
  • Celiac disease (Gluten enteropathy): A chronic autoimmune inflammation of the small intestine mucosa, triggered by gluten ingestion, improving with a gluten-free diet.

⚠️ Etiology / Risk Factors:

Acute Enteritis:

  • Infectious causes:
  • Viral: Rotavirus, Norovirus, Enterovirus, HIV (rare chronic form)
  • Bacterial: Staphylococcus, E. coli, Campylobacter, Salmonella
  • Fungal: Candida (esp. in immunocompromised)
  • Protozoa: e.g., Giardia lamblia
  • Vascular: Ischemic enteritis due to shock
  • Radiation: Radiation-induced mucosal damage
  • Autoimmune: Crohn’s disease (IBD), eosinophilic enteropathy

Chronic Enteritis / Celiac Disease:

  • Autoimmune reaction to prolamins (gliadin, glutenin) in wheat, barley, rye
  • Genetic predisposition (HLA-DQ2, HLA-DQ8)
  • Environmental triggers
  • Lactase deficiency may coexist

Pathogenesis (Celiac Disease):

  • Gluten contains gliadin → partially digested → triggers immune response
  • T-cell mediated inflammation leads to:
  • Villous atrophy
  • Crypt hyperplasia
  • Loss of absorptive surface
  • Leads to malabsorption of nutrients (iron, folate, B12, fat-soluble vitamins)

Symptoms:

General Enteritis:

  • Diarrhea (incr secretion and motility).
  • Constipation (if spastic colon or reduced motlitiy)
  • Nausea, vomiting, often of gastric contents
  • Abdominal pain (epigastric or diffuse)
  • Fever (if infectious), fatigue, myalgia

Celiac Disease:

  • Diarrhea, bloating, flatulence
  • Heaviness after meals, meteorism
  • Weight loss, fatigue, anemia (due to malabsorption)
  • In children: growth retardation, abdominal distension

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