PMC420464_01
Course of a patient with celiac disease. Her response to gluten free diet (GFD) was inadequate despite a good compliance. This might have resulted from small intestinal bacterial overgrowth (SIBO) as addition of antibiotics with disappearance of SIBO (as evidenced by a negative glucose hydrogen breath test, GHBT) resulted in resolution of symptoms. EMA: anti-endomysial antibody.
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F1
The subsequent treatment and course is depicted in Fig. 1. Despite good compliance to it, there was inadequate symptomatic response (Fig. 1), even though D-xylose test result was normal one y after presentation [urinary excretion over 5 h after ingestion of 5 g D-xylose 1.5 g (normal >=1 g)].
PMC420464_02
Course of the other patient with celiac disease. Her response to gluten free diet (GFD) was inadequate despite a good compliance as she continued to pass 4-5 liquid stools/day. She was found to have lactose intolerance (LI). Inadequate response to GFD might have been due to LI as withdrawal of lactose from diet resulted in complete resolution of symptoms. Other abbreviations used: Bx: biopsy; PVA: partial villous atrophy; EMA: anti-endomysial antibody; LHBT: lactose hydrogen breath test; LT: lactose tolerance test.
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F2
The subsequent course is shown in Fig. 2. Based on these, a diagnosis of lactose intolerance was made and lactose-free diet was started; diarrhea resolved during follow-up (Fig. 2).