Autoimmunity in Diarrhoeal Disease

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Abstract
Evidence for autoimmunity in diarrheal disease is reviewed. Celiac disease (CD) is considered. The incidence of tissue-reactive autoantibodies in adults and children with CD (68% and 65%, respectively) is higher than the incidence of these autoantibodies in controls (6% in normal adults and 14% and 9% in disease controls drawn, respectively, from adult and child populations). The R1 antireticulin antibody, when present, was found to disappear after several weeks on a gluten-free diet, but in contrast, other autoantibodies persisted. A case is argued for a new disease category, namely autoimmune enteropathy; 7 cases are reviewed in which patients presented with protracted diarrhea, a small intestinal enteropathy which failed to heal during periods of total parenteral nutrition and evidence of a predisposition to autoimmunity (the presence of high titer autoantibodies including 1 specific for gut epithelium, and/or the presence of associated diseases regarded to be autoimmune). Evidence for autoimmunity in inflammatory bowel disease is reviewed and includes discussion of serum goblet cell antibodies and of circulating T cells which participate in antibody-dependent cellular cytotoxicity in vitro using colonic epithelial cells as targets. An unusual child is described who presented with chronic diarrhea and a flat small intestinal mucosa, who responded to gluten withdrawal but who later relapsed spontaneously during a strict gluten-free diet. Her mucosa healed only after a period of total parenteral nutrition and treatment with oral steroids. This child''s enteropathy was also associated with thyrotoxicosis and a microscopic colitis.