Early or pre-coeliac mucosa: development of gluten enteropathy.

Abstract
Duodenal mucosa showed normal morphology, interepithelial lymphocytes, alkaline phosphatase and sucrase in a girl with growth retardation and Fe deficiency, but normal absorption of lactose and xylose after 2 yr of abnormal stools. Mucosal lactase was low. Fourteen months later, mucosal damage consistent with celiac disease was evident and gluten intolerance was subsequently confirmed by gluten challenge. In some children, the mucosal lesion probably occurs very gradually, so that at an early stage with normal morphology, suppression of lactase activity and possibly interference with Fe absorption may be the only abnormalities.