Summary
Definition
History and exam
Key diagnostic factors
- prolonged exposure to an endemic area
- constitutional symptoms
- diarrhea
- bloating
- foul-smelling, greasy stools
- glossitis
- numbness of fingers and toes
Other diagnostic factors
- abdominal cramping
- fever
- leg swelling
- hair loss
- cheilitis/angular stomatitis
- pedal edema
- hyperactive bowel sounds/borborygmi
- hyperpigmentation/eczematous rash
- pallor
- dry eyes
- corneal xerosis
- decreased deep tendon reflexes/decreased vibratory sensation
- night blindness
Diagnostic tests
1st tests to order
- CBC
- quantitative fecal fat assay
- D-xylose test
- serum folate
- serum vitamin B12
Tests to consider
- stool ova and parasites (O and P)
- stool culture
- upper gastrointestinal endoscopy with biopsy
- folic acid therapeutic trial
Treatment algorithm
Contributors
Authors
Daniel Wild, MD
Professor of Medicine
Division of Gastroenterology
Duke University Medical Center
Durham
NC
Disclosures
DW declares that he has no competing interests.
Iris L. Vance, MD
Assistant Professor of Medicine
Division of Gastroenterology
Duke University Medical Center
Durham
NC
Disclosures
ILV declares that she has no competing interests.
Acknowledgements
Dr Daniel Wild and Dr Iris L. Vance would like to gratefully acknowledge Dr Moises Guelrud, a previous contributor to this topic. MG declares that he has no competing interests.
Peer reviewers
J. Thomas LaMont, MD
Professor of Medicine
Harvard Medical School
Division of Gastroenterology
Beth Israel Deaconess Medical Center
Boston
MA
Disclosures
JTLM declares that he has no competing interests.
Daniel Leffler, MD, MS
Instructor in Medicine
Harvard Medical School
Director of Clinical Research
The Celiac Center
Beth Israel Deaconess Medical Center
Boston
MA
Disclosures
DL declares that he has no competing interests.
Paul Ciclitira, MBBS, MD, PhD
Professor of Gastroenterology
Department of Diabetes and Nutritional Sciences
King's College London
Rayne Institute
St Thomas' Hospital
London
UK
Disclosures
PC declares that he has no competing interests.
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