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Gluten Enteropathy and Skeletal Disease

John R. Ross, MD; S. Peter Gibb, MD; Donald E. Hoffman, MD; Eugene P. Clerkin, MD; Willard E. Dotter, MD; Lewis M. Hurxthal, MD
JAMA. 1966;196(3):270-274. doi:10.1001/jama.1966.03100160120035.
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This exhibit illustrates our experience with the problem of a primary absorption defect commonly recognized as gluten enteropathy, and it focuses attention principally on one of its least emphasized manifestations which relates directly to skeletal abnormalities.

Scope  Gluten enteropathy, an entity variously termed nontropical sprue, celiac disease of adults and children, and idiopathic steatorrhea, is primary malabsorption usually associated with inflammation and villous atrophy of the small-bowel mucosa. Although gluten enteropathy is frequently observed in childhood, the symptoms of the disease may appear for the first time in adult life.The mucosal changes appear to result from local toxicity caused by gliadin, the water-soluble fraction obtained from the alcohol extraction of gluten, a protein found primarily in wheat, barley, oats, and rye. The mechanism of this mucosal toxicity has not been established, but current knowledge suggests that an inborn error of metabolism exists which is manifested as a deficiency of


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