Adult coeliac disease in South Africa. An analysis of 20 cases emphasizing atypical presentations.

This is the first comprehensive report of coeliac disease from South Africa. Twenty patients with adult coeliac disease diagnosed in Johannesburg between 1966 and 1978 are reviewed. It is noted that a significant number did not present with the classic features of the disease. Secondary nutritional manifestations were frequently absent, and may have been masked in some patients by self-medication or by the prescription of vitamins and haematinics before the diagnosis was made. The majority of patients were from the middle or upper socio-economic class, and few complained of anorexia, nausea, vomiting or abdominal pain. It is therefore possible that many maintained an adequate intake of nutrients throughout the course of their illness. The severity of diarrhoea and steatorrhoea did not correlate with the state of nutrition of the patients as assessed by a variety of blood studies. Megacolon, present in 2 patients, responded to a gluten-free diet. An interesting observation was that patients diagnosed after the age of 40 years had been symptomatic for a much shorter period of time than younger patients.