The typical patient is middle-aged.
Clinical features of ulcerative small bowel disease:
(1) fever
(2) abdominal pain
(3) bloating
(4) diarrhea
(5) protein-losing enteropathy with hypoalbuminemia
(6) malabsorption with steatorrhea
The presence of ulcers can be made with standard endoscopy if extensive. For more limited disease capsule endoscopy can be used.
Patients with celiac sprue-related ulcerative small bowel disease will have diagnostic features of celiac sprue (serologic, histologic).
Some patients improve with a strict gluten-free diet but a patient with refractory celiac disease may not.
Exclusions – other causes of small bowel ulcerations:
(1) infectious enteritis (Yersinia, Campylobacter, etc)
Patients with celiac disease ulcerative small bowel disease are at increased risk for enteropathy-associated T-cell lymphoma (EATL).
