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Celiac disease is a malabsorption syndrome in which atrophy of the villi (minute projections) within the intestines occurs as a result of exposure to gluten, the primary protein component of wheat flour. It is now becoming clear that many cases of celiac disease exist without symptoms of malabsorption or resulting malnutrition. Furthermore, it is also becoming clear that celiac disease is a systemic disease (affecting many systems of the body), and involves pathological events outside the intestine and is apparently unrelated to malnutrition. The authors report the cases of five patients who developed dementia and who were subsequently found to have celiac disease. One patient was 58, the others were 39 years of age or younger at the time of presentation. Two of the patients were sisters. The patients were confirmed to have celiac disease on the basis of a biopsy of the small intestine, and were placed on a gluten-free diet. Unfortunately, the gluten-free diet resulted in an improvement in symptoms in only one patient. The remaining four patients continued to suffer a downward course towards dementia; computed tomography revealed atrophy of the cerebral cortex of the brain in the four deteriorating patients. In two patients, the serum level of vitamin B12 was found to be low, a condition which was likely to be the result of the condition of the small intestine. However, the use of vitamin B12 supplements in these patients did not result in an improvement in symptoms. It is not known how long the five patients suffered celiac disease prior to its diagnosis; none of the patients were malnourished or had obvious symptoms of the malabsorption syndrome. It is not known, therefore, whether earlier diagnosis and dietary restriction might have halted the downward slide of their mental faculties. The details of the cases, however, suggest that the mental deterioration which occurred was not simply a result of malnourishment stemming from the intestinal dysfunction. Rather, it would seem that dementia may be a direct complication of celiac disease in some patients. The cause of the dementia in these patients remains unknown. The authors caution that celiac disease must be considered as a possible cause of dementia, especially when seen in a young patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

Between 1970 and 1973, 94 patients underwent Nissen fundoplication for gastroesophageal reflux; 60 of the 94 patients returned for follow-up study in 1982. The same surgeon operated on all the patients, and another physician who did not participate in the treatment interviewed the attending patients. Four patients (7 percent) had persistent symptoms, 7 patients had recurrent symptoms (in 3, during the first postoperative year, and in four, 2 to 10 years postoperatively), and 47 (78 percent) had postfundoplication symptoms which were moderate in most but disturbing in some. Some technical details in the performance of the fundoplication could reduce the frequency of the fundoplication symptoms. Because recurrent symptoms may appear late, even 10 years or more after operation, a definitive evaluation of the results of Nissen fundoplication is impossible to perform.