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Five patients with adult coeliac disease were treated with prednisolone for four to five weeks while continuing a normal gluten-containing diet. A prompt histological, ultrastructural and enzymic recovery of the jejunal mucosa in all five was accompanied by an incomplete metabolic response in three of four patients tested. These findings are discussed in relation to the possible immunological pathogenesis of coeliac disease.

In 9 out of 10 adults in whom a diagnosis of coeliac disease had been made in childhood, the diagnosis was confirmed by the finding of a flat intestinal mucosa. None showed abnormal physical signs, but three had a haemoglobin concentration below 10 g./100 ml. and all those not receiving folic acid supplements showed low serum folate levels. Five had moderate to severe symptoms at the time of investigation, but none was receiving treatment with a gluten-free diet.Periodic investigation of these patients may be necessary throughout life, and if they are found to have malnutrition they should be treated with a gluten-free diet.

This paper demonstrates that in man, as in the rat, increasing amounts of fat reach more distal levels of the small intestine as the dietary load increases.