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Enteropathy – Causes, Symptoms and Treatment
Enteropathy is a general medical term for any disease affecting the intestine, impairing its lining and function. It can arise from various causes and lead to digestive complaints.
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Enteropathy is a general medical term for any disease affecting the intestine, impairing its lining and function. It can arise from various causes and lead to digestive complaints.
What is Enteropathy?
Enteropathy is a broad medical term referring to any disease or functional disorder of the intestine, particularly the small or large intestine. The word derives from the Greek enteron (intestine) and pathos (disease, suffering). Enteropathies can damage the intestinal lining, impair nutrient absorption, and disrupt normal bowel function. Because the term covers a wide range of conditions, it is often used together with a qualifier that specifies the cause or type – for example, gluten-sensitive enteropathy (coeliac disease) or protein-losing enteropathy.
Causes
Enteropathies can be triggered by a variety of factors:
- Autoimmune reactions: In gluten-sensitive enteropathy (coeliac disease), the immune system attacks the intestinal lining in response to gluten.
- Infections: Bacteria, viruses, or parasites can cause acute or chronic intestinal disease.
- Inflammatory bowel disease: Conditions such as Crohn's disease and ulcerative colitis are chronic inflammatory enteropathies.
- Medications: Certain drugs, especially non-steroidal anti-inflammatory drugs (NSAIDs), can cause NSAID-induced enteropathy.
- Allergies and food intolerances: For example, cow's milk protein enteropathy in infants.
- Impaired blood supply: Insufficient blood flow to the intestine can result in ischaemic enteropathy.
- Radiation therapy: Abdominal radiation can lead to radiation-induced enteropathy.
- Genetic factors: Rare congenital conditions can permanently impair intestinal function.
Symptoms
The symptoms of enteropathy vary depending on the underlying cause and the section of the intestine affected. Common complaints include:
- Chronic or recurrent diarrhoea
- Abdominal pain and cramping
- Bloating and a feeling of fullness
- Weight loss and malnutrition
- Nausea and vomiting
- Signs of nutritional deficiency (e.g., anaemia, fatigue, brittle nails)
- In severe cases: oedema (fluid retention) due to protein loss
Diagnosis
Diagnosing enteropathy typically requires several investigative steps:
- Medical history and physical examination: Questions about diet, symptoms, medications, and pre-existing conditions.
- Blood tests: Detection of inflammatory markers, antibodies (e.g., anti-transglutaminase antibodies in coeliac disease), and nutritional deficiencies.
- Stool tests: Detection of pathogens, blood, or fat malabsorption.
- Imaging studies: Ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) of the abdomen.
- Endoscopy with biopsy: Examination of the intestine (colonoscopy or gastroscopy) with tissue sampling for histological analysis – often the key step in reaching a definitive diagnosis.
Treatment
Treatment is always tailored to the underlying cause of the enteropathy:
- Dietary measures: A lifelong gluten-free diet is essential in coeliac disease. Other food intolerances are managed by eliminating the trigger food.
- Drug therapy: Anti-inflammatory medications (e.g., corticosteroids, mesalazine) for inflammatory bowel conditions; antibiotics or antiparasitic agents for infections.
- Immunosuppressants and biologics: Severe chronic inflammatory enteropathies may require immunosuppressive drugs or monoclonal antibodies.
- Nutritional supplementation: Correcting deficiencies with targeted supplements (e.g., iron, vitamin B12, folic acid, vitamin D).
- Discontinuing causative medications: In NSAID-induced enteropathy, the responsible drug is stopped wherever possible.
- Surgical intervention: In rare, severe cases, surgery may be necessary.
References
- Longo, D. L. et al. (eds.) – Harrison's Principles of Internal Medicine, 21st edition. McGraw-Hill Education, 2022.
- European Crohn's and Colitis Organisation (ECCO) – Clinical Guidelines on Inflammatory Bowel Disease. Available at: https://www.ecco-ibd.eu
- World Gastroenterology Organisation (WGO) – Global Guidelines: Celiac Disease. Available at: https://www.worldgastroenterology.org
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