PANCREATIC FUNCTION AND DISEASE IN EARLY LIFE. I. PANCREATIC ENZYME ACTIVITY AND THE CELIAC SYNDROME 1

Abstract

The clinical features of idiopathic celiac disease include characteristic wasting, more in the limbs than in the face; distension of the abdomen, which may be soft, doughy, and inelastic, or markedly distended and tight; bulky, foul-smelling, frothy stools which contain excess fat; and, often, re- tardation of growth. To these findings may be added clumping of barium in the small intestine, a flat glucose tolerance curve, and a low rise in the vitamin A in the blood during the vitamin A ab- sorption test (1). It is now recognized that these clinical and laboratory findings are encountered not only in idiopathic celiac disease but that many, if not all, may appear also as a result of, or in as- sociation with, congenital malformations of the small intestine and particularly of its mesenteric attachment, chronic infections such as tubercu- losis of the peritoneal cavity, obstruction to the lacteals, megacolon, and a number of other dis- ease states. This series of conditions, unrelated etiologically but capable of producing a common clinical picture, have been brought together in re- cent years under the term celiac syndrome.